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COPYRIGHT DEPOSIT 






BEFORE 
THE BABY COMES 

A PRACTICAL, NON-TECHNICAL 
MANUAL FOR PROSPECTIVE MOTHERS 

BY 

MARIANNA V/HEELER 

FOR TWENTY YEARS SUPERINTENDENT 
OF THE BABIES' HOSPITAL, NEW YORK 




HARPER & BROTHERS PUBLISHERS 

NEW YORK AND LONDON 

MCMXI V 






BOOKS FOR THE HOUSEHOLD 

BEFORE THE BABY COMES, by Marianna 
Wheeler. 16mo. Cloth. 

EDUCATING THE CHILD AT HOME, by 
Ella Frances Lynch. 

THE YOUNG MOTHER'S HANDBOOK, by 

Marianna Wheeler. 16mo. 

PRINCIPLES OF CORRECT DRESS, by 
Florence Hull Winterburn. 16mo. 

GOOD FORM FOR ALL OCCASIONS, by 
Florence Howe Hall. 

NOVEL WAYS OF ENTERTAINING, by 
Florence Hull Winterburn. 16mo. 

COOK BOOK OF LEFT-OVERS, by Clark 
and Rulon. 16mo. 

SOCIAL USAGES AT WASHINGTON, by Flor- 
ence Howe Hall. 16mo. 

HOW TO KEEP HOUSEHOLD ACCOUNTS, 
by Charles Waldo Haskins. 16mo. 

THE EXPERT MAID SERVANT, by Christine 
Terhune.Herrick. 16mo. 

HYGIENE FOR MOTHER AND CHILD, by 
Dr. Francis H. MacCarthy. Post 8vo. 

MANNERS AND SOCIAL USAGES. Ill'd. 
Post 8vo. 

THE EXPERT WAITRESS, by Anne Frances 
Springsteed. New Edition. 16mo. 

THE BABY, HIS CARE AND TRAINING, 
by Marianna Wheeler. Revised edition 
16mo. 

HOW TO BE BEAUTIFUL, by Marie Mon- 
taigne. Illustrated. 



HARPER & BROTHERS, NEW YORK 



COPYRIGHT. 19 14, BY HARPE R a BROTHERS 

PRINTED IN THE UNITED STATES OF AMERICA 

PUBLISHED OCTOBER, 1914 

K-O 



OCT 29 iai4 

CU387257 



/ 




CONTENTS 

CHAP. PAGE 

I. Introduction i 

II. Development of the New Life ... n 

III. The Signs and Disorders of Pregnancy 20 

IV. Incidental Disturbances of Preg- 

nancy 41 

V. Miscellaneous 51 

VI. The Hygiene of Pregnancy .... 69 

VII. Preparations for Confinement ... 88 

VIII. The Lying-in Period 107 

IX. The Mother and Babe 124 

X. Clothing the Baby 135 

XL Breast-feeding 141 

XII. Bottle-feeding 150 

Index 167 



BEFORE THE BABY COMES 



BEFORE 
THE BABY COMES 



INTRODUCTION 

NORMAL development, good general 
health, and healthy pelvic organs 
should be the: aim of all women. To 
obtain these, attention must be given to 
hygiene, especially by young girls. The 
organs of generation are the last to reach 
their full development, and when a girl 
is lacking in health and vitality the un- 
developed organs are prone to take on 
disease; heredity also must necessarily 
have some influence upon them. Lowered 
vitality, specific diseases, and physical 



2 BEFORE THE BABY COMES 

defects may be handed down by one or 
both parents. But even in such cases, by 
proper living and hygienic measures, much 
may be corrected and overcome. 

Proper attention should be paid to a 
certain amount of out-of-door exercise. 
This should not be carried to excess, but 
there should be enough to keep the muscles 
strong and healthy and to improve circu- 
lation. Daily baths should be taken in 
order to keep the pores of the skin open 
and clean, thus aiding in throwing off the 
body poisons. Young girls should eat 
sufficient nourishing food to furnish energy 
and growth as well as to replenish bodily 
waste. Careful attention should be given 
to the bowels. There should be a daily 
movement to prevent the absorption of 
poisons from the waste matter. These, if 
not passed from the body through the 
bowels, naturally escape into the system. 
The bladder should be emptied frequently 
enough to prevent its distension, as an 
over-distended bladder may cause a dis- 
placement of the uterus. 

During menstruation a certain amount 
of rest should be taken. Violent exercise 



INTRODUCTION 3 

should not be indulged in, and exposure to 
cold should be avoided as much as possible. 
When it is necessary to go out in storms or 
in severely cold weather a girl should be 
well protected against the elements. Cloth- 
ing should be worn sufficiently loose not to 
constrict any part of the body, especially 
the abdomen, and it should be warm 
enough for real comfort, not for imaginary 
protection. Late hours and nervous or 
mental strain should be avoided. 

Few young women about to assume the 
responsibilities of motherhood have more 
than a vague idea, if any, of the organs of 
generation. These organs do not come to 
their full development until the period of 
pregnancy. It would probably be of little 
help to the prospective mother to go into a 
detailed and technical description of them, 
but it will help her to have a little def- 
inite knowledge of the position of the 
reproductive organs and their relation to 
each other. 

The pelvis is a bony girdle or cavity 
situated low down in the abdomen, the 
bones which outline it being held in posi- 
tion by fibrous bands or ligaments. This 



4 BEFORE THE BABY COMES 

cavity is bowl or basin shaped, open and 
broad at the top. The sides are lined with 
muscle, as is also the base. In this bony 
basin lie the internal organs of generation 
— i. e.> the uterus, or womb; the ovaries, 
which contain the female element; the 
fallopian tubes, which connect the ovaries 
with the womb; and the vagina, which is 
the outlet through which the infant passes 
at birth. The pelvis also contains the 
kidneys, the bladder, and the rectum. 

The uterus is a pear-shaped organ. 
Normally it is three inches long, two inches 
wide at its broadest part, and about one 
inch thick, and is composed more or less 
of elastic muscular tissue. It can readily 
be seen why it must be elastic, as the fetus 
increases in weight from about one-six- 
teenth of an ounce, which is its weight the 
first month, to between seven and eight 
pounds, the average weight at birth. The 
uterus lies in the center of the pelvis, be- 
tween the folds of a broad membrane 
called the broad ligament, which extends 
across from one side of the pelvis to the 
other. Besides this broad ligament there 
are two smaller cord-like ligaments on 



INTRODUCTION 5 

either side. The upper or broad part of 
the uterus, called the fundis, is free and 
movable. The lower or smaller part is 
called the cervix, or neck, and projects 
into the upper part of the vagina, where 
it is loosely encircled by it. In the center 
of the cervix, corresponding to where the 
stem of the pear is attached, is a small 
opening called the os, or mouth, which 
leads through the neck into the hollow of 
the uterus. Before a woman becomes 
pregnant this canal is so small that it 
scarcely admits the end of an ordinary 
knitting-needle. 

The ovaries are two oval-shaped bodies 
one and one-half inches long and a third 
of an inch thick. They lie on the broad 
ligament, on either side of the uterus. 
Within the ovaries is the female element 
called the ovum, or egg. Each ovary con- 
tains from forty to seventy thousand ova 
at birth, but these do not ripen or mature 
until about the twelfth or sixteenth year. 
At this age they escape once a month from 
the membrane, or sac, inclosing them and 
travel through the fallopian tubes toward 
the uterus, to be either cast off or to meet 



6 BEFORE THE BABY COMES 

the male element and become impregnated. 
The presence of both or even of one ovary- 
is not necessary for conception. As long 
as even a small part of one ovary remains, 
if it contains healthy ova, and if there is 
no obstruction of the fallopian tubes or of 
the passage leading from the uterus to the 
outside, conception may take place. 

The fallopian tubes are two partly mus- 
cular tubes leading from the ovaries to the 
uterine cavity. At the end attached to 
the ovaries they are quite broad, but grow 
gradually smaller, becoming quite small 
as they enter the uterus. These, like the 
ovaries, are held in place by the broad 
ligament. Occasionally a fertilized ovum 
may remain in the tube and develop there. 
This is called a tubal pregnancy. As it is a 
serious condition, it should be recognized 
early in order to obtain relief by operation. 
It is best always to consult a physician 
early in pregnancy, even though this com- 
plication is rare. 

The vagina is a canal two and a half to 
three and a half inches long which leads 
from the uterus to the outside of the body. 
It encircles the lower part of the womb and 



INTRODUCTION 7 

extends downward through the pelvic floor, 
or perineum, as it is properly called. The 
vagina is very elastic and admits of a great 
deal of stretching at the birth of the child, 
while the perineum, which is of firmer elas- 
tic muscle, acts as a support to keep the 
pelvic organs in place as well as to help 
support the enlarged organs during the 
first three months of pregnancy. After 
this time it is relieved of their weight, as the 
uterus, by its own weight, begins to be 
lifted higher up in the pelvis. 

During childbirth the perineum plays an 
important part by its resistance and by 
directing the advancing part, which is 
usually the head, in the right direction 
toward the outlet. Sometimes when the 
child advances so rapidly that the muscles 
are forced, or when the body is too large in 
proportion to the outlet, or if for some 
reason the muscles are rigid and unyielding 
or thin and weak, the perineum is apt to 
become torn. When the tear is a tiny one, 
sewing it up is usually not necessary, as it 
will in a very short time repair itself and 
heal without interference. But if the tear 
is more than a small nick one or more 



8 BEFORE THE BABY COMES 

stitches should be put in immediately, 
according to the extent of the laceration, 
unless there is some good reason for not 
doing so. This will prevent misplacements 
of the uterus, and better results are ob- 
tained than if it is left for months without 
repairing. If it is not done the uterus, 
without the support of the firm pelvic 
flooring, is apt to sink down from its nor- 
mal position and tip backward or forward. 
When this flooring is very badly torn and 
not properly repaired within a reasonable 
time there is a sagging of the vaginal walls 
which bring down with them the walls of 
the rectum or the bladder, and in the 
worst cases both. This is frequently the 
cause of constipation and bladder trouble. 
In fact, the combination of ills resulting 
from neglected lacerations is the cause of 
severe backache and other troubles from 
which so many young married women 
break down, become nervous wrecks, and 
grow old before their time. 

During pregnancy the abdominal mus- 
cles naturally become stretched. This is 
caused by the enlarging fetus, which crowds 
and distends all the abdominal contents. 



INTRODUCTION 9 

In women whose muscles are healthy and 
firm the abdomen usually returns to nor- 
mal shape after childbirth, but in those 
who have weak, soft muscles and those 
who have frequent and rapid pregnancies, 
with no time for recuperation between, 
the muscles are apt to remain permanently 
soft and flabby, resulting in a large abdo- 
men. Sometimes a separation of the cen- 
tral muscles may occur, causing rupture. 
The difficulty or ease with which a child 
is born depends chiefly upon the following : 
the size of the bony pelvis, the rigidity or 
flexibility of the fibrous bands that hold 
the bones together, the strength of the 
contractions of muscles of both abdomen 
and uterus, and the size of the child. If 
the child is fairly small and compares 
favorably with the size of the bony pelvis, 
if the ligaments and muscle lining of the 
pelvis are soft and flexible, then everything 
is favorable to a normal and comparatively 
easy confinement. On the other hand, if 
the pelvis is small, the muscles and liga- 
ments rigid, and the child large in pro- 
portion to the size of the pelvis (which does 
not necessarily mean an over-large baby), 



io BEFORE THE BABY COMES 

labor and delivery are correspondingly 
more painful and difficult. 

The muscular contractions of the uterus 
also play no small part in the propelling 
forces that usher the child into the world, 
as it is the contractions of the muscles of 
the uterus that force the child downward 
toward the neck of the uterus. It is also 
these contractions that cause the first 
labor pains, which indicate the first stage of 
labor, usually the most painful stage. As 
the uterus lies between the rectum and the 
bladder, both of these should be empty at 
this time, as a full rectum and bladder 
pressing against the uterus from opposite 
sides make a strong resistance to the 
advancing child. During this first stage 
of labor it is a mistake for a woman to 
strain; it does no good and merely adds to 
her exhaustion. It is at the second stage 
of labor, during which the child passes 
through the vagina to the outside, that the 
contractions of the abdominal muscles 
play an important part, and straining 
helps. This is a less painful stage. The 
third and last stage of labor is when the 
placenta, or afterbirth, is expelled. 



II 

DEVELOPMENT OF THE NEW LIFE 

CONCEPTION. As has been said, in 
the mature woman, or at the child- 
bearing age, every twenty-eight or thirty 
days the ovum bursts from its capsule, or 
cell, and escapes from the ovaries and 
commences to work its way toward the 
uterus, either to become fertilized or to be 
cast off. The union of the ovum, which is 
the female element, and the spermatozoon, 
or the male element, is called conception. 
Without the union of these two elements 
the child cannot develop. Just as an 
unfertilized hen's egg cannot develop into 
a chick, so an unfertilized human ovum, 
or egg, cannot develop into a child. Life 
is present from the time of conception, 
which is the instant these two elements 
meet, and to destroy this life is as much 

2 



12 BEFORE THE BABY COMES 

feticide as the destruction of the child in 
the later months of pregnancy, when it is 
perfectly formed. Fertilization may take 
place in the tube or in the uterus. In 
either case the fertilized ovum is finally 
conveyed to the hollow of the uterus, where 
it attaches itself to the lining, or mucous 
membrane, of that organ and there be- 
gins on its steady growth. 

By the end of the first month the fetal 
structures can be recognized. Heart, liv- 
er, and kidneys are being formed, and it is 
thought that the heart beats at the third 
week. The embryo (as it is called until 
it assumes a distinctive shape) is about 
one-third of an inch long. 

During the second month the bones be- 
gin to form, eyes, ears, and nose are dis- 
tinguished, and the external genitals are 
apparent, but sex cannot be determined. 
The outlines of hands and feet appear. 
The embryo measures one and a quarter 
inches in length and weighs about one- 
sixteenth of an ounce. 

By the end of the third month, or twelfth 
week, the embryo is three and a quarter 
inches in length and weighs about four 



DEVELOPMENT OF THE NEW LIFE 13 

ounces and a quarter. The external parts 
are distinctly formed, the fingers and toes 
are separated, eyelids cover the eyes, and 
lips close the mouth, and for the first time 
it fills the entire cavity of the uterus. 
Fetal movements commence, though rare- 
ly discernible by the mother. 

By the fourth month the embryo has as- 
sumed such definite shape and charac- 
teristics that it is called the fetus. It is 
about five inches in length, weighs about 
eight ounces, and sex is clearly defined. 
If miscarriage occurs, it may live for some 
hours. 

At the end of the fifth month the 
fetus averages from eight to nine inches 
in length, and weighs seventeen ounces. 
Heart-sounds may be heard through the 
abdominal walls on careful examination 
by a physician. Hair and nails begin to 
develop. It is early in this month that 
the mother usually feels movements. If 
born during this month it may breathe, 
possibly cry out, and live several hours. 

The sixth month, or twenty-fourth week, 
the length of the fetus is about twelve 
inches. It weighs between one and one- 



i 4 BEFORE THE BABY COMES 

half and two pounds; there is hair on the 
head; there are eyebrows and eyelashes. 
The umbilical cord, which at the second 
month was barely an inch long, now meas- 
ures fourteen inches, and the baby begins 
to grow fat. If born at this age it has 
been known in exceptional cases to live 
two weeks, but usually dies in a few hours. 

During the seventh month the baby meas- 
ures from fourteen to fifteen inches and 
weighs from two and one -half to three 
pounds. Babies born alive at this time 
rarely live, but the nearer they approach 
the full term the greater the chances are. 

At the eighth month the length is about 
sixteen and one-half inches; weight, three 
and a half to four pounds. A child born 
now may live, with care. 

The ninth month the length is about 
seventeen inches ; weight, about six pounds. 
If born, the child will live, with proper care. 

At the end of the tenth month, or forty 
weeks, which is full term, the length of the 
child is from nineteen to twenty inches, 
and the average weight seven to seven and 
a half pounds. Some full -term babies 
weigh ten pounds; higher weight than 



DEVELOPMENT OF THE NEW LIFE 15 

this is rare, and is usually guessed at or 
is false. A baby at birth should be fairly 
plump, its skin pink, toe-nails and finger- 
nails fully formed, and extending slightly 
below the tips. Its eyes should be open. 
The umbilical cord should be about twenty 
inches long. 

Impregnation of the ovum usually oc- 
curs in the fallopian tube, and at once the 
wonderful changes commence. The united 
or merged male and female element, or 
egg, immediately divides in half, these 
halves are again divided, and these sub- 
divisions keep recurring until the yolk is a 
mass of cells that are going to form the 
different organs, skin, hair, nails — in fact, 
every atom that goes to make the body 
complete. In normal pregnancy this mass 
of cells finds its way to the hollow of the 
uterus, where it attaches itself to its mem- 
branous lining. During the first three 
months the embryo is inclosed in a shaggy 
shell, called the chorion, which somewhat 
resembles a chestnut - burr, with small 
thread-like ducts on its exterior, full of 
blood-vessels. After the third month 
the greater part of these ducts or loops 



16 BEFORE THE BABY COMES 

become thin and glistening and form with 
another stronger membrane a bag con- 
taining a watery fluid, in which the child 
floats. The part of the chorion that re- 
mains is firmly attached to one side of the 
upper part of the uterus; it increases in 
thickness, and becomes almost circular in 
shape; this portion is now called the pla- 
centa, full of loops of blood-vessels, which 
dip into the depressions of the lining of 
the uterus like fingers in a mass of dough. 
The fetus is nourished in this way until 
full grown. It receives its nourishment 
and gets rid of its waste matter through 
two arteries and one vein, which run 
through the umbilical cord, attached at 
one end to the child's navel, where they 
are continuous with the fetal circulation, 
and at the afterbirth at the other end, 
which is separated from the mother's 
circulation by a thin membrane. From 
this it will be seen that at no time during 
pregnancy is there any direct connection 
between the circulation of the mother and 
that of the child. What interchange of 
food and waste substance there is between 
the two is by absorption only. 



DEVELOPMENT OF THE NEW LIFE 17 

The fluid in the membranous bag in 
which the child floats is called the amniotic 
fluid. It keeps the bag distended, making 
room for the child to grow and move. It 
also protects the fetus against injuries, 
caused by blows on the mother's abdomen 
or by falls. The impact, being trans- 
mitted through the soft uterine walls and 
the amniotic fluid, loses most of its force 
before it can reach the fetus. At full 
term this fluid is usually about a quart, 
and its escape is what is known as the 
"breaking of the waters." When this 
fluid is scanty, or has escaped prematurely, 
the birth is called a dry one, and is usually 
more difficult, as the canal is not as well 
dilated as though the water remained to 
act as an opening force when the first labor 
pains press the child's head downward. 
If the bag does not rupture or break, as is 
sometimes the case, it comes away with the 
child, the membrane forming a caul, or 
veil, with which some supposedly lucky 
babies are born. 

During the early months of pregnancy 
the fetus may assume various positions in 
the uterine cavity. But by the beginning 



18 BEFORE THE BABY COMES 

of the last month it usually takes its 
permanent position, lying vertically, with 
its head pointing downward, the head and 
back curved forward, the chin resting on 
the chest. The legs are drawn up on the 
abdomen, and the arms are crossed on the 
chest. 

The following changes take place in the 
mother's generative organs. The uterus, 
in order to provide nourishment for the 
growing fetus, receives a greater supply 
of blood, and from a small body weighing 
one or two ounces it grows until at full 
term it weighs about two pounds. Its 
length increases from two and three-fourth 
inches to approximately fifteen inches; also 
its neck becomes slightly larger, but not 
in proportion to the other parts. The 
walls become thicker and softer from the 
added _blood-supply; and the opening, or 
mouth, becomes larger, especially toward 
the later months. The vagina becomes 
thicker, longer, and softened. Congestion 
causes it to assume a violet or bluish color, 
and it is covered with a larger amount of 
secretion. The vulva also shows the effect 
of the added blood-supply and becomes 



DEVELOPMENT OF THE NEW LIFE 19 

thicker and deeper in color. In the later 
months of pregnancy the veins of the 
vulva are much enlarged from pressure, 
or even become varicose. The ligaments 
of the pelvis become softer and more 
movable. 

The duration of pregnancy is about two 
hundred and eighty days, counting from 
the first day of the last menstrual period. 
A quick method of getting the approximate 
date is to count backward, from the first 
day of the last menstruation, three months, 
and add seven days, or count forward 
nine calendar months and add seven days. 
Either way, this is as near the date as can 
be calculated. In about one in twenty it 
comes on the exact date, and in more than 
one-half it comes within a week of the 
date, usually within a few days. Confine- 
ment reckoned from the quickening is not 
to be depended upon, but is valuable as a 
guide to the possible date, when a nursing 
mother becomes pregnant without a return 
of the menstrual period. 



Ill 

THE SIGNS AND DISORDERS OF PREGNANCY 

THE early signs of pregnancy are so 
well known by many women that 
they can usually make a diagnosis with 
more than a fair amount of certainty. 
These well - known signs, however, are 
merely probable ones; the only positive 
signs are said to be, first, when the doctor 
can distinctly feel the outlines of the 
child's body through the abdominal walls; 
second, the actual birth of the infant itself. 
It is not unusual for a woman in her anx- 
iety to become a mother, or through fear 
of becoming one, to imagine that she is 
pregnant, especially if for some unknown 
cause her menstrual flow has ceased for a 
time. Sometimes she will even go through 
the entire nine months, confident that all 
the well-known signs of pregnancy have 



SIGNS OP PREGNANCY 21 

been hers. These cases, however, are not 
common. 

The common signs of pregnancy, and 
those which are usually recognized as being 
a safe guide, are, first, the cessation of the 
monthly periods. If a woman has always 
been regular in this respect, and if there 
is delay or cessation at the time when 
the flow is due to appear, there is good rea- 
son for her to suspect the probability of 
pregnancy. It may be well, however, to 
mention here some of the things other than 
pregnancy that may and do occasionally 
cause a cessation of the monthly periods. 
These are cold, change of climate (this 
frequently causes the menses to cease for 
months or even as long as a year), over- 
fatigue, strong emotions, general debility, 
excessive desire to become pregnant, or 
fear' of becoming so; also certain dis- 
eases, as anemia, pneumonia, dysentery, 
diphtheria, ovarian and specific diseases. 
Under the usual conditions when a woman 
misses two successive menstrual periods 
she may feel fairly positive of her condi- 
tion. Then there are times when a woman 
menstruates, or apparently does so, during 



22 BEFORE THE BABY COMES 

pregnancy, and the condition is not sus- 
pected until " quickening' ■ makes the fact 
known. While this condition does not 
always indicate danger, it is best to consult 
a physician. 

About the beginning of the second month 
the breasts become tender and somewhat 
larger; they begin to feel heavier, and 
often beat and throb. The nipples grow 
larger and more prominent, the pigmented 
or colored circle around them becomes 
deeper and, as time goes on, broader. 
The depth of color varies according to the 
complexion of the woman. It grows only 
slightly deeper in blondes, much darker in 
brunettes, and really black in negroes. 
The veins of the breasts become more 
prominent. Sometimes as early as the 
third month, but usually later, there is a 
watery secretion found in the breasts, 
which is called colostrum, and is fre- 
quently so abundantly secreted that it 
flows spontaneously from the breasts. To 
a mother who has recently nursed her 
child these changes mean nothing, as 
milk may remain in the breasts for some 
months after weaning. Occasionally there 



SIGNS OF PREGNANCY 23 

is a lack of gland- tissue in the breasts. In 
this case the breasts do not develop, and 
there is a deficiency or entire lack of 
colostrum and, later, of milk. 

The Bladder. At about the time the 
breasts begin to change the bladder also 
shows signs of irritation. This is caused 
by the gradually enlarging uterus, which 
lies between the rectum and the bladder, 
pressing on the latter and making it im- 
possible for that organ to hold the usual 
amount of urine. Hence the necessity of 
emptying the bladder frequently. Also at 
this time the bladder and the tubes leading 
from it, as well as all the pelvic organs, 
have an increased blood supply, which has 
a tendency to cause a burning or scalding 
sensation before and during the passage 
of urine. This is not a sign of kidney 
trouble, as many women fear. About the 
end of the third month, sometimes a little 
later, the uterus rises in the pelvis, which 
relieves the pressure, and these annoying 
symptoms disappear. They return, how- 
ever, when the uterus, in the latter part 
of pregnancy, again sinks low down in 
the pelvic cavity. This usually occurs 



24 BEFORE THE BABY COMES 

from two to four weeks before confine- 
ment. 

Morning sickness, or vomiting, is a most 
disagreeable and in many cases a most dis- 
tressing symptom of pregnancy. It occurs 
early and lasts usually until the end of the 
third month. Unfortunately, this symp- 
tom does not always confine its activity to 
the morning; frequently the attacks oc- 
cur at night, and occasionally at intervals 
during the entire day. This will be dis- 
cussed more fully in another chapter. 

Another early and usual sign experi- 
enced by many pregnant women is a gen- 
eral disturbance of the digestive organs, 
which comes in more forms than one. It 
may be lack of appetite; hunger, with a 
distaste for food or for the odor of cooking; 
or an unnatural craving for certain things. 
Women may also suffer from so-called 
heartburn and flatulency. These, how- 
ever, are minor disturbances, and do not 
occur as frequently as morning sickness. 

Abdominal change is another significant 
sign of pregnancy. First comes the in- 
crease in size of the abdomen. During the 
first months this is not particularly notice- 



SIGNS OF PREGNANCY 25 

able. The navel, which naturally is de- 
pressed, begins to rise level with the sur- 
face of the abdomen, or it may protrude 
considerably. A faint dark line appears, 
extending from the navel downward; this 
becomes darker as pregnancy progresses. 
Later there appear on the abdomen fine, 
white, irregular lines, which are caused by 
the unusual stretching of the skin; the 
skin, too, frequently becomes dry and 
scaly. From the end of the fourth 
month there is a steady increase in the 
size of the abdomen, usually varying from 
three-quarters of an inch to two inches or 
more each month. 

The first sign of life or movement of the 
fetus is called quickening, and is one of 
the surest " probable' ' signs of pregnancy. 
While there are undoubtedly feeble move- 
ments before the mother is conscious of 
them, they are not usually felt before the 
sixteenth week, although women who have 
had children are more sensitive to the 
movements, and some claim they have felt 
life as early as the fourteenth week. The 
first signs of life are invariably likened to 
the fluttering of a bird held in the hand, 



26 BEFORE THE BABY COMES 

• 

and this sensation is frequently accom- 
panied by a feeling of faintness. Women 
pregnant for the first time are sometimes 
not conscious of life before the eighteenth 
or twentieth week. The movements usu- 
ally increase in liveliness and strength as 
time passes, much to the discomfort of 
some. Malnutrition of the mother is said 
to stimulate the child to greater activity. 
When this is great enough to disturb the 
mother's rest at night a drink of warm 
milk, malted milk, or cocoa will usually 
quiet the activity and produce sleep in 
the mother. 

It is not unusual for the fetal movements 
to apparently cease or remain quiet for 
days or even weeks, but this need not 
necessarily be the cause of anxiety, even 
if they have previously been vigorous. 
Many women when this condition occurs 
fear the child must be dead, yet later 
bring into the world a healthy living child. 
It is best, however, to allay worry by hav- 
ing a physician listen for the fetal heart- 
beats, a sure sign of the child's vitality. 

While pregnancy is a physiological and 
natural process and the organs of genera- 



DISORDERS OF PREGNANCY 27 

tion are simply fulfilling the purpose for 
which they were intended, there are, never- 
theless, certain disturbances incidental to 
this period from which many women suf- 
fer. Most of these are due to the press- 
ure of the enlarging womb on the neigh- 
boring organs and blood-vessels, and many 
of the ailments require no treatment 
other than simple hygienic care. All wom- 
en do not suffer from them; many women 
go through pregnancy in apparently bet- 
ter health than is usual for them. Acci- 
dental illness which one may contract at 
any time should not be attributed to this 
condition. 

Nausea and vomiting occur in about fifty 
per cent, of the women who are carrying 
a first baby. It is less frequent in wom- 
en who have previously had children. It 
may appear as early as the first week, but 
more often comes about the time when the 
monthly period first fails to appear, and 
it is likely to continue with more or less 
severity for three months or until the 
time of " quickening.' ' There is a popular 
belief that a "sick pregnancy" indicates an 

easy confinement. As far as labor is con- 
3 



28 BEFORE THE BABY COMES 

cerned, the presence or absence of nausea 
has no influence on it whatever. As the 
nausea and vomiting occur more often in 
the morning than at other times, it is com- 
monly called morning sickness. Women 
who are nauseated or vomit in the early 
morning can usually eat a good breakfast 
and experience no further or very little 
trouble during the rest of the day. There 
are others who are rarely sick in the morn- 
ing, but may be affected at any time dur- 
ing the day, especially after meals. These 
cases, however, are not numerous. There 
may be simply nausea with retching, or 
actual vomiting of mucus, stomach secre- 
tions, or bile. Ordinarily, enough food can 
be eaten and retained, so that nutrition 
does not suffer. When nausea and vomit- 
ing persist most of the time and are severe 
enough to interfere with proper nourish- 
ment, or when they persist beyond the 
fifth month, the condition is not normal 
and a physician should be consulted. 

Among the things thought to contrib- 
ute to this condition are: inflammation 
and displacements of the uterus; disease 
of the ovaries; irritation of the uterine 



DISORDERS OF PREGNANCY 29 

nerve, due to expansion of the uterus; 
previous stomach trouble; eye-strain and 
coitus at this time. Lately it has been 
suggested that the condition is due to a 
mild auto-intoxication, which later corrects 
itself. It is not always a simple matter 
to control the nausea and vomiting of 
pregnancy, but when the trouble is not un- 
usually severe simple means will often be 
found more helpful than recourse to drugs, 
which should never be taken without the 
advice of a physician. 

In the first place, avoid, when possible, 
the conditions that contribute to cause 
nausea. Do not eat rich and indigestible 
foods or foods that are known to disagree 
with you. Drink enough water to cause 
the kidneys to act freely; bathe frequently; 
take some exercise in the open air every 
day, and see that there is a daily movement 
of the bowels. Simple remedies said to be 
excellent in warding off morning sickness 
are a cup of hot bouillon, chicken, mutton, 
or clam broth, or strong clear coffee taken 
an hour before rising in the morning, the 
patient remaining quiet afterward. A 
glass of milk kept at the bedside and occa- 



30 BEFORE THE BABY COMES 

sional sips taken between midnight and 
morning is also good. 

During the day take a sandwich con- 
sisting of raw, scraped beef, spread rather 
thickly between two very thin slices of 
dry bread; the yolk of a hard-boiled egg; 
a little ice-cream, and sometimes a little 
fresh, crisp popcorn, or a toasted cracker 
will settle the stomach. When vomiting 
occurs after meals, instead of eating three 
heavy meals a day it is well to have four or 
five light meals consisting of hot broth 
or a glass of milk and vichy and one of the 
above-mentioned articles of food. A crisp 
piece of hot toast may be added if desired. 
Local treatment may consist in placing a 
cold compress of cracked ice to the back of 
the neck. A little cracked ice may also be 
swallowed from time to time. Hot flan- 
nels placed on the abdomen, or a mustard 
paste on the stomach, 1 often have a good 
effect. When vomiting is very severe and 
persistent, and nothing seems to help, it is 
well to go to bed for a week or two, drink 
plenty of water, and confine one's self to a 

1 The stomach is situated about where the breast- 
bone separates. 



DISORDERS OF PREGNANCY 31 

diet of milk and vichy at intervals of two 
and a half or three hours. A little cereal 
may also be taken. The chief requirement 
is rest. 

Constipation usually attends pregnancy, 
whether there has been a predisposition to 
it before this period or not. A woman who 
has never before been constipated will usu- 
ally suffer to some extent, and one who has 
been habitually constipated before will be 
more so than ever. This is caused chiefly 
by the torpid action of the intestines, or 
diminished intestinal contractions; press- 
ure from the enlarged uterus helps to 
cause the condition. Occasionally diar- 
rhea occurs instead of the usual consti- 
pation, but this is not common. It is 
more likely to occur early or late in preg- 
nancy, and is probably caused by some 
indiscretion in diet or unusual pressure. 
Constipation is a condition that should not 
be carelessly overlooked, since bodily waste 
is increased during pregnancy, owing to 
the changes that are going on and the 
added burden of eliminating the child's 
waste matter, which is reabsorbed into the 
mother's blood. This makes it important 



32 BEFORE THE BABY COMES 

that refuse should not accumulate and re- 
main in the intestines, as much that is un- 
healthy in the form of poisons will be again 
reabsorbed by the mother. 

During this period there should be at 
least one good-sized movement from the 
bowels every day. If several days or a 
week are allowed to pass without a bowel 
movement it causes an additional burden of 
excretion to be thrown upon the kidneys, 
which are now working more actively than 
usual; and to overwork the kidneys is a 
serious matter. Constipation at this time 
is the frequent cause of anemia, headache, 
backache, dizziness, mental dullness, lassi- 
tude, fatigue, hemorrhoids or piles, and 
varicose veins; the latter are always ag- 
gravated by this condition. Constipation 
also causes a tendency to abortion. It is 
better, if possible, to overcome constipa- 
tion by careful diet, laxative foods, and 
habit than to obtain relief by the constant 
use of drugs, enemas, and suppositories. 
The first step is to form the habit of 
a daily movement at a certain time, pref- 
erably after a meal, as the muscular con- 
tractions of the bowels are more active 



DISORDERS OF .PREGNANCY 33 

then, being stimulated by digestion. Even 
though there be no desire at that time, re- 
peated attempts daily at the same hour 
will go far toward establishing success. 
As most of the waste accumulates in the 
bowels bvernight, the best time to empty 
them is after breakfast. 

A glass or two of hot or cold water on 
arising in the morning and on retiring at 
night is an excellent factor in helping to 
overcome constipation, especially in con- 
nection with a laxative diet. The fruits 
and vegetables more or less laxative are: 
apples, peaches, pears, oranges, prunes, 
dates, figs, tamarinds, rhubarb, spin- 
ach, summer squash, asparagus, dandelion 
greens, and most of the early green vegeta- 
bles. Of the cereals oatmeal and yellow 
corn meal and graham meal are the best. 
Bread made from rye or whole- wheat flour, 
corn muffins, and bran gems or bran bis- 
cuits are excellent, especially the latter, 
which rarely fail to have the desired effect. 
The bran gems are laxative in that they 
form the stimulus that removes the bulk 
of refuse. Buttermilk, lactic - acid milk, 
kumyss, and matzoon are all beneficial. 



34 BEFORE THE BABY COMES 

When constipation is very stubborn it 
may be necessary to start with a mild 
laxative, such as cascara sagrada. This 
may be given in small doses, from fifteen 
to twenty drops three times a day, until 
the habit of regularity has become estab- 
lished. Then gradually discontinue its use 
by dropping one dose every two or three 
days until none is taken. Depend upon 
habit and laxative food. The habit of 
taking an enema every' day is not to be 
encouraged. The bowels are naturally 
sluggish at this time, and the more they are 
relieved by enema the more they will re- 
quire artificial aid of this kind to obtain 
results. When the bowels have not moved 
for several days an enema of soap-suds or 
oil, or a glycerine suppository, may be 
necessary in order to start the hardened 
contents of the bowel. 

Flatulency. As the pressure of the en- 
larged womb prevents the passage of food 
through the intestines as quickly as usual, 
there is a tendency for it to ferment before 
it reaches the rectum. The treatment or 
prevention consists in overcoming constipa- 
tion, if it exists, and following the advice 



DISORDERS OF PREGNANCY 35 

given for heartburn as to food and so forth. 
Buttermilk or lactic-acid bacteria in tab- 
let form may be used with benefit. Also 
some of the simple remedies, such as milk 
of magnesia, soda-mint tablets, or charcoal 
tablets taken in hot water. 

Varicose veins axe not common during 
first pregnancies, but are apt to occur in 
those that follow. They do not usually in- 
dicate anything serious. They are caused 
from pressure and disappear when this 
pressure is relieved by the birth of the 
child, provided the mother remains in bed 
long enough to restore her circulation. 
The enlarged veins may occur in both legs, 
but are usually more pronounced in the 
right one. There is slight danger of their 
bursting or breaking down if they are 
given proper support. Treatment con- 
sists in avoiding constipation, supporting 
the abdomen by a properly fitted band or 
corset, and keeping off the feet as much 
as possible. Women who have their own 
housework to do will be surprised to find 
how many duties they can perform while 
sitting. While doing so it is well to elevate 
the feet on a stool or chair. The best 



36 BEFORE THE BABY COMES 

means of getting relief and support for the 
bulging veins is by bandaging the legs 
from the toes to the knee or thigh. Make 
the bandages of coarse, thin flannel or 
muslin, four inches wide and seven yards 
long, cut on the bias or straight. Roll 
the bandage before applying it. A stock- 
ing of light material that laces up the 
front is now made for the purpose of giving 
support to these veins, and is much more 
practical and less expensive than the silk 
stocking usually worn. It is not neces- 
sary to wear either bandage or stocking at 
night. Sometimes the vulva becomes very 
much enlarged. In this case a pad, kept 
in place by wearing a T-bandage, will 
offer support and relief. 

Swellings of the legs and feet are from the 
same cause as varicose veins, and are not 
common in first pregnancies. This symp- 
tom is rarely alarming, although some- 
times most uncomfortable, especially when 
it affects the entire leg and vulva, as it 
sometimes does. About the only relief to 
be obtained is by lying down at intervals 
or remaining in bed for half a day. A 
snug bandage also helps slightly. 



DISORDERS OF PREGNANCY 37 

Hemorrhoids are usually the result of 
constipation and straining caused by that 
condition. They are the cause of much 
discomfort and often of severe pain. They 
usually disappear after the child's birth. 
Treatment for this trouble is, first of all, to 
regulate the bowels and avoid straining. 
If there is much inflammation bathe the 
parts frequently with cold extract of witch- 
hazel, and if the hemorrhoids protrude re- 
place them, using vaseline freely in so 
doing. An enema consisting of one ounce 
of witch-hazel and one ounce of cold wa- 
ter is also very good. Medicated salves 
and suppositories should not be used unless 
advised by a physician. 

Vaginal Discharges. There is frequently 
a slight vaginal discharge early and late in 
pregnancy which usually requires no treat- 
ment. But if the discharge is profuse and 
of a yellow-greenish color it is best to 
consult a physician and have him advise 
treatment. 

Douches are not advisable for any pur- 
pose without medical direction. When the 
conditions are such, however, that a physi- 
cian cannot be reached or consulted a 



38 BEFORE THE BABY COMES 

woman will have to use her discretion as 
to the advisability or necessity for a 
douche, but it should not be used when 
there is an absence of discharge. When 
the doctor is not consulted a douche 
should not be taken oftener than two or 
three times a week, or, at most, every 
other day, and only a pint of water should 
be used. The water should be ninety-eight 
degrees, not hot, and a teaspoonful of com- 
mon salt or one of boric acid may be dis- 
solved in it. The bag holding the water 
should be hung low, as the water should 
enter the vagina very slowly and gently. 
The best time to take this douche is just 
before going to bed at night. 

The decay and loss of teeth is not as 
general now as it was, because more care 
is given to the teeth and mouth than 
formerly. During pregnancy there is an 
increased acidity of the stomach and the 
secretions of the mouth, which has a 
tendency to cause the teeth to decay. In 
order to correct this acidity efforts to over- 
come the indigestion which causes it should 
be made. The mouth should be kept very 
clean and free from particles of food. The 



DISORDERS OP PREGNANCY 39 

teeth should be carefully brushed at night 
and in the morning, and after each meal 
the mouth thoroughly rinsed, using a half- 
glass of water with either a teaspoonful of 
milk of magnesia or a quarter of a teaspoon- 
ful of bicarbonate of soda in the water. 
The mouth should also be well rinsed after 
vomiting. It was formerly thought that 
dental work during pregnancy would bring 
on a miscarriage or cause harelip or deform- 
ity of the child. This is not so, but tooth- 
ache, ulcerated teeth, or abscess of the 
gums caused by decayed teeth are capable 
of working much harm by impairing the 
health and nerves. Married women should 
keep their teeth in the best possible condi- 
tion at all times, and as soon as pregnancy 
becomes known visit a good dentist and 
have the teeth carefully examined. The 
filling of teeth or even extraction may be 
done, excepting in the case of a very 
nervous and excitable woman, when it is 
well not to add to the already overwrought 
condition. If the dental work is extensive 
or of a very painful nature the sittings 
should be short and only temporary work 
done. 



4 o BEFORE THE BABY COMES 

Heartburn during pregnancy is quite 
common, and is due to a very acid condi- 
tion of the stomach. The acid rises into 
the°throat, causing a disagreeable burning 
sensation. Preventative measures are the 
best means of avoiding this trouble. All 
foods of a rich, fatty, or greasy nature 
should be avoided. Cream, olive-oil, or 
excess of butter should not be taken with 
meals. If taken into the stomach at all 
it should be at least twenty minutes be- 
fore the meal. Too much candy or sweets 
will cause acidity. The " Fletcher' ' sys- 
tem of chewing the food very finely and 
thoroughly is an excellent preventative. 
Heartburn rarely develops if the above 
suggestions are strictly observed, but if 
already present it may be somewhat con- 
trolled by drinking large quantities of wa- 
ter to dilute the acid, or by taking twenty 
grains of bicarbonate of soda (in either 
powder or tablet form) or a teaspoonful of 
milk of magnesia or lime-water, in a glass of 
water when the burning sensation is felt. 



IV 

INCIDENTAL DISTURBANCES OF PREGNANCY 

yj BORTION, miscarriage y and prema- 
**- ture labor are terms used when preg- 
nancy is interrupted; in other words, when 
for some cause the fetus is expelled from 
the uterus before the term of pregnancy is 
completed. Abortion is the term generally 
used when this occurs before the fourth 
month ; if expelled between the fourth and 
seventh months it is called miscarriage; 
between the seventh and full term, prema- 
ture labor. The causes of this condition 
are many, some more significant than 
others. 

The most common causes are inflam- 
mation of the lining of the uterus (when 
this condition exists the fertilized ovum is 
not as likely to adhere to the sides of the 
uterus or obtain the proper nourishment), 



42 BEFORE THE BABY COMES 

displacements and malformations of the 
uterus, kidney poisons or toxemias peculiar 
to this period, syphilis, and criminal inter- 
ference. The first mentioned is the most 
common cause and one that is usually 
easily remedied by a minor operation 
called curettage. This consists of scraping 
away the inflamed surface, which is usually 
replaced by a new and healthy membrane. 
It is well known that many women at- 
tempt to produce abortion by measures 
that are to be condemned. Any act to 
destroy the life of the fetus by interference 
is not only criminal, but it deliberately in- 
vites ill-health in many forms, principally 
nervous diseases which not infrequently 
end in insanity. Other factors which may 
produce abortion, miscarriage, and pre- 
mature labor are rapid and successive 
pregnancies; excessive coitus; obesity; 
very high altitudes and hot climates, when 
one is not accustomed to living in such; 
also tuberculosis, pernicious anemia, and 
diseases which are accompanied by a very 
high fever; prolonged and intermittent 
fever; mental shock, and unusual excite- 
ment. 



INCIDENTAL DISTURBANCES 43 

Occasionally abortion seemingly becomes 
a habit, the women being apparently per- 
fectly healthy and having regular and 
painless menses. In such cases there is 
strong reason to suspect internal inflamma- 
tion or displacements, although some wom- 
en seem to have what is called an irritable 
uterus, and abort with the slightest jars 
of the body, over-reaching, or slight devia- 
tion from the usual life or routine. 

The symptoms of abortion vary slightly 
with the month. During the first six 
weeks of pregnancy abortion may be ac- 
companied with little or no pain, but there 
may be marked hemorrhage, and, as the 
ovum is usually cast off intact, it frequently 
passes off unnoticed. If abortion occurs 
between the sixth and twelfth weeks, which 
is a time when it most commonly occurs, 
the pain and hemorrhage are apt to be 
more severe. The embryo escapes first, 
then the membrane. There may be 
slight chills, backache, and nausea, and if 
the hemorrhage is very profuse faintness 
and exhaustion which may last for several 
days. During the later months miscar- 
riage or premature labor is attended with 



44 BEFORE THE BABY COMES 

more danger. Sometimes operative inter- 
ference is necessary. The dangers of in- 
terrupted pregnancy are frequently greater 
than those of a normal or full-term preg- 
nancy, as there may be a serious loss of 
blood or blood-poisoning from a portion or 
the whole of the membrane being retained, 
with the possibility of causing inflamma- 
tion and later displacements. 

When there is a predisposition to abor- 
tion, and they occur frequently, preventa- 
tive measures are important and the fol- 
lowing rules should be observed. Rest in 
bed on menstrual dates, as miscarriages 
are very apt to occur at these times. 
There should be no intercourse at men- 
strual dates, and pregnancy should not fol- 
low an abortion for several months or a 
year, as the uterus requires rest. Avoid 
constipation, as a full rectum and a full 
bladder are common causes of displace- 
ments which cause abortion. Tiring exer- 
cises, standing long at a time, riding over 
rough roads, lifting and over-reaching, are 
all to be avoided. In case of severe cough- 
ing or vomiting a doctor should be called 
at once for means of relief. 



INCIDENTAL DISTURBANCES 45 

The common symptoms of approaching 
abortion are slight hemorrhage, backache, 
bearing-down pains, and a feeling of full- 
ness in the pelvis. Too much dependence 
must not, however, be placed on the latter 
symptoms, especially when slight, as con- 
stipation will cause them. But whenever 
there is the slightest discharge of blood 
with the above symptoms a woman should 
go to bed immediately in a darkened room, 
where she can have absolute quiet, and lie 
on her back with as little change of position 
as possible. A simple turning in the bed 
has been known to bring on hemorrhage. 
If the hemorrhage is slight and ceases with 
this treatment, it is best for the patient not 
to get up before two or three days have 
passed. It is then possible that pregnancy 
may progress without further interruption; 
but if after getting up the bleeding should 
return, she should go back to bed and re- 
main there two or three weeks. 

Whenever abortion is threatened it is 
always best, if possible, to call a doctor 
immediately. But as doctors are some- 
times difficult, if not impossible, to reach, 
and the condition of the patient is such as 



46 BEFORE THE BABY COMES 

to require quick and strenuous treatment, 
the following suggestions may prove help- 
ful. 

When there is profuse bleeding, the foot 
of the bed should be raised and cold com- 
presses applied to the lower part of the 
abdomen and vulva. When the flow 
diminishes materially the bed may be 
lowered, but the patient must remain in 
bed for several days after it entirely ceases. 
If the hemorrhage continues profusely a 
very hot douche of boric-acid solution may 
be given. After miscarriage the patient 
should receive the same careful treatment 
as after confinement. She should remain 
in bed at least ten days; longer if she does 
not regain her strength. There is the same 
danger, as after confinement, of displace- 
ments and inflammation if she is on her 
feet too soon. 

Tuberculosis and Pregnancy. Women 
who are known to have active tuberculosis 
of the lungs should not marry as long as 
this condition prevails. Neither should 
girls having had incipient tuberculosis and 
apparently recovered marry early, as there 
is little doubt that pregnancy has an un- 



INCIDENTAL DISTURBANCES 47 

favorable influence on such cases. The 
nine months of the waiting period are a 
drain on the system, and the loss of blood, 
shock, and exhaustion incident to labor 
cannot help but impair the vitality and 
more or less lower the powers of resistance. 
Frequent pregnancies are apt to stir up 
an incipient or dormant tuberculosis into 
an active and progressive one. Children 
born under these conditions are usually 
delicate. Not that they inherit tubercu- 
losis. This they rarely do, but they in- 
herit a lack of resistance to this disease 
as well as to diseases in general. A mother 
with active tuberculosis should not nurse 
her baby, as nursing might subject it to 
direct infection through her. 

Toxemia. During the process of diges- 
tion certain poisons are formed in the body, 
which are eventually carried to the liver 
to be purified into non-poisonous elements, 
which the kidneys throw off. When the 
liver does not perform its functions per- 
fectly these poisons are supposed to collect 
in the blood and cause symptoms known 
as toxemic. During pregnancy, for some 
reason, the liver does not perform its 



48 BEFORE THE BABY COMES 

functions as a clearing-house for these 
poisons as well as usual, and the tendency 
toward toxemia increases, and is helped 
along by constipation, lack of exercise, and 
indiscretions in diet. These hinder the 
free excretion of body waste and throw 
more work upon the kidneys. 

The early symptoms of mild toxemia are 
nausea and vomiting, constipation, dizzi- 
ness, perverted tastes, and so forth. Care- 
ful attention to diet, bathing, exercise in 
the open air, keeping the bowels regular, 
and drinking plenty of water will help dis- 
pel these symptoms and prevent them 
from becoming more serious. The more 
serious symptom of toxemia is pernicious 
vomiting, which becomes incessant and so 
pronounced that the mother's health is 
undermined from lack of nourishment. 
Every means possible should be taken to 
relieve this condition, such as rest in bed, 
with only liquid food in small quantities, 
carbonated waters, mustard paste applied 
to the stomach at frequent intervals, free 
purging of the bowels, washing out the 
bowels with warm salt solution (using two 
teaspoonfuls of salt to a quart of water), 



INCIDENTAL DISTURBANCES 49 

and drinking large quantities of water, that 
it may dilute and carry off the toxins or 
poisons in the system. When all else fails 
pregnancy may have to be interrupted. 

Eclampsia and convulsions are the most 
serious symptoms of toxemia, but are, 
fortunately, not common. The warning 
symptoms are headache, dizziness, buzzing 
in the ears, pain at the pit of the stomach, 
spots before the eyes, vomiting, and a feel- 
ing of excitement or depression. The pre- 
ventive treatment is the hygienic pre- 
caution already mentioned. Women who 
have chronic or acute kidney trouble should 
be carefully watched by their physicians 
from the beginning to the end of pregnan- 
cy. Sometimes there is an absence of pro- 
nounced symptoms of toxemia; at other 
times many of the symptoms are present 
without apparent toxemic infection. In 
such instances the only means of determin- 
ing the presence or absence of these poisons 
is by an examination of the urine. If the 
mother has the symptoms of toxemia and 
an analysis of the urine shows no indi- 
cation of poison her relief of mind is sure- 
ly recompense for taking the precaution. 



^*r 



50 BEFORE THE BABY COMES 

If toxins in the form of urea or albumen are 
found the condition in most cases can be 
overcome by treatment and diet, and her 
precautions will have been the means of 
saving two lives, her own and the infant's. 
Occasional examination of the urine of all 
pregnant women is strongly advised. 



MISCELLANEOUS 

TOXIGENICS (called the science of im- 
■*-* proving the human race by better 
breeding) is still very much in its infancy. 
At present there are national and inter- 
national conferences being held on this 
subject, and from data and statistics that 
have been and are being collected civiliza- 
tion in general is beginning to realize that 
it is better to bring a strong race into the 
world than to save a weak one. The 
value of the world is not alone in great 
numbers of babies, but to have a great 
number of healthy babies born. The ob- 
ject of eugenics, therefore, is to direct the 
mating of the physically fit, with the de- 
sign of rooting out the weakness of an- 
cestry and by so doing influence the 
offspring. 



52 BEFORE THE BABY COMES 

While many conclusions may be drawn 
from experiments in mating animals, the 
conditions which influence men are some- 
what more complex and the probabilities 
are that it may require many years of ob- 
servation, covering many generations, be- 
fore any set of rules can be formulated to 
carry conviction. At present there is a 
difference of opinion as to whether the 
strong alone should mate, or whether the 
weak should mate with the strong, some 
authorities claiming that strong traits may 
exist in the weak, that these traits are 
dormant, and that marriage with the 
strong will bring them out. All, however, 
agree that it is wrong for the weak to 
marry the weak, since their children can- 
not fail to be weaklings. Notwithstand- 
ing the aims of eugenics, there are other 
outside influences in the molding of man. 
Hygienics is also a factor not to be over- 
looked, and it must not be forgotten 
that deformed and feeble-minded children 
have been born of parents whose ancestors 
have been, from a eugenic point of view, 
all that is desirable as far as could be dis- 
covered. Of eourse, an accident, say of 



MISCELLANEOUS S 3 

environment, reacting on the germ-plasm, 
may account for this. 

It is known that a child's inheritance is 
fixed when the male and female elements 
fuse at the moment of conception, and that 
inherited characteristics or traits are car- 
ried in the germ -plasm of each parent. 
But according to some selective process, 
the laws of which are not yet understood, 
a part of the germinal cell, which contains 
these inheritable qualities, is cast off from 
both ovum and spermatozoon when they 
ripen. Just what determines which are 
thrown off and which retained is not 
known; at any rate, those retained account 
for the combination of inherited charac- 
teristics of the child. 

Abnormalities of the child come from an 
imperfect germ-plasm at the time of con- 
ception. These deviations from normal 
may come as heritance or may be acquired 
through the influence of some outside fac- 
tor, such as alcohol or drugs taken to a de- 
gree which poisons the system. Or the 
toxins from acute fevers, syphilis, and 
chronic inflammation of the organs of 
generation may affect and change the cell. 



54 BEFORE THE BABY COMES 

Means of Controlling Size of Family. As 
has been said before, the great need at 
present is not so much more children as 
better children. A moderate-sized family 
of healthy children well cared for and well 
educated is far more desirable than many 
weaklings improperly nurtured and edu- 
cated. Childbirths following too quickly 
one upon another soon tend to impair the 
health of mother and child. Abortion is 
not only against the laws of nature, but is 
an illegitimate practice forbidden by law 
and punishable as a crime. It is claimed 
that women suffer ill-health from abor- 
tion mpre than from all other causes 
combined; a visit to any hospital or 
insane - asylum will prove the truth of 
this statement. That a few women 
who practise it do escape unscathed is 
simply a matter of luck, and no one knows 
who the lucky one may happen to be. 

Interrupted or incomplete intercourse is 
distinctly harmful to the health. " Over- 
production,' ' in the words of a well-known 
physician, "not only cheapens the product 
in the matter of children, but does more — 
it weakens or destroys the source of sup- 



MISCELLANEOUS 55 

ply." There are one or two resources, 
however, usually dependable and legiti- 
mate, by which the size of a family may 
be controlled. 

A previous chapter describes how once in 
every twenty-eight or thirty days a ripened 
ovum leaves the ovary and travels toward 
the uterus. Usually it leaves the ovary 
and commences its travels a few days be- 
fore the menstruation is established. If 
not impregnated by the male element it 
may pass away with the menstrual flow or 
it may not leave until the fourteenth day. 
After the ovum is discharged the chance of 
conception is over for the time being, or 
until the next ovum escapes and starts on 
its journey. From this it will be seen that 
in order to avoid impregnation there should 
be no sexual intercourse for approximately 
twenty days in each lunar month, leaving 
about eight days during which it may be 
indulged with safety. The danger period 
is four or five days before the menstrual 
period, during this period, and for twelve 
or fourteen days after it. Another preven- 
tative, fairly reliable, is to wash out the 
vagina by means of a hot douche imme- 



56 BEFORE THE BABY COMES 

diately after coitus, before the spermato- 
zoon travels far enough to enter the uterus. 
The water should be hot, and a teaspoonful 
of boric-acid powder added to each pint 
of water contributes to its efficacy. The 
nozzle of a syringe should be inserted well 
into the vagina, and the bag containing the 
water should be hung six feet high in order 
that the water enter the passage with force 
enough to thoroughly wash it out. 

First Pregnancies Late in Life. Some 
women do not become pregnant until they 
are past their thirty-fifth year, either 
through marrying late in life or apparent 
sterility early in life. In some cases bar- 
renness is due to displacements, inflam- 
mation, tumors, or malformations. These 
corrected, pregnancy takes place. Some- 
times the cause lies in the husband's in- 
ability to procreate. In this case the wife 
may be sterile in a first marriage and be- 
come pregnant in the second. 

Many women who have passed their 
thirty-fifth year without having experi- 
enced pregnancy look upon it now with 
fear as to the outcome, but they may find 
comfort and courage in the opinion of one of 



MISCELLANEOUS 57 

the best authorities on obstetrics, who states 
that there is no sound basis for the tradi- 
tion that the neck of the womb, or cervix, 
is always rigid in women not young who 
conceive for the first time. He also states 
that the only influence of age upon first 
pregnancies is that the first stage of labor is 
slightly prolonged, and it also slightly in- 
creases the chance of forceps being used in 
delivery. 

It is well for a woman under the fore- 
going conditions to place herself in the 
hands of a competent physician and care- 
fully observe the rules of hygiene suggest- 
ed in the preceding pages. If she lives 
far from a doctor it would be well to make 
arrangements to enter a sanatorium for her 
confinement. The only unfortunate cir- 
cumstance an older woman may experience 
is in nursing her baby. Her breasts may 
not readily respond to the stimulus for 
milk, and she may have to feed the baby 
by artificial means. 

It is not at all unusual for many women, 
during the early months of pregnancy, to 
show much nervous irritability. Women 
who have heretofore been amiable and of a 



58 BEFORE THE BABY COMES 

cheerful disposition become peevish, dis- 
agreeable, and frequently apprehensive and 
melancholy. They are also hysterical and 
cry on the slightest provocation. This is 
not to be wondered at when one considers 
the unusual changes the system is under- 
going. All the functions are doing extra 
work. New tissues are actively growing, 
and glandular secretions have greatly in- 
creased. Happily, nervous symptoms usu- 
ally subside as pregnancy progresses and 
the woman becomes more accustomed to 
these new changes. They disappear en- 
tirely with the relaxation that comes with 
confinement. 

Occasionally the reverse conditions oc- 
cur. Women who previous to pregnancy 
have been of nervous temperament now 
become happy and cheerful. During this 
period of nervous strain it is well for a 
woman, for her own sake, to make a brave 
fight to overcome any nervous tendencies; 
nevertheless, she is not in a condition to 
put up as strong a resistance as she might 
desire, and it is only just that she should 
receive every consideration and encourage- 
ment from her husband and those about 



MISCELLANEOUS 59 

her. Patience and kindness go far to re- 
lieve the mental strain at this time. 

Pruritis, or itching, is not uncommon. 
When the itching is not confined to any par- 
ticular location, but is general, it may be due 
to some disorder of the kidneys or liver; 
there may be too much sugar in the urine, or 
possibly, it is thought, the system may con- 
tain some poison peculiar to pregnancy. 
When this condition is general it is im- 
portant that on no account should a day 
pass without a full movement of the 
bowels. The urine should be examined, 
and water drunk freely. Plenty of fruit 
should also be eaten, and baths with 
washing - soda in the water should be 
taken. Use one pound of the soda to 
an ordinary bath-tub of water. When 
the itching is local it may be caused by 
leucorrhea, ulcers of the rectum, or piles. 
Bathing the parts frequently with olive-oil, 
washing-soda solution, or a saturated solu- 
tion of boric acid will give relief. A good 
toilet - powder will also have a soothing 
effect when applied. 

Inverted Nipples. If the nipples are nat- 
urally flat or inverted some effort should 



60 BEFORE THE BABY COMES 

be made to overcome this defect. One 
method is to heat a good-sized bottle, by 
repeatedly pouring hot water into it, until 
thoroughly warmed, then pour off the wa- 
ter, and place the mouth of the bottle 
over the nipple. This draws it out. A 
piece of cloth wrung out of cold water and 
wrapped around the bottle hastens the 
effect of the treatment. Another way to 
draw out the nipples is to take a common 
clay pipe, smooth the edges of the bowl, and 
attach a short piece of rubber tubing to the 
stem. Place the bowl over the nipple and 
the tubing in the mouth and draw on it, 
which will bring the nipple out. Either 
treatment may be tried two or three times 
a day for a few minutes with excellent 
results. In spite of treatment, however, 
the defect sometimes cannot be remedied. 

The Breasts. If the breasts are not 
properly protected and kept warm they 
may become very painful at this time. 
When there is pain it is advisable to cover 
them with a thin strip of flannel. 

Sleeplessness during pregnancy may be 
caused by nervousness, constipation, toxe- 
mia, and many minor discomforts common 



MISCELLANEOUS 61 

to this period. This trouble is sometimes 
overcome by regulating the diet. A warm 
bath, or a drink of milk or of hot malted 
milk just before going to bed, will often 
have a soothing effect and induce sleep. 
Drugs that produce sleep should not be 
taken, as the drug habit is very easily 
formed when one is in this condition, and 
very difficult to overcome at any time. 

Cramps in the legs and back are not serious, 
but are sometimes the cause of much dis- 
comfort. They are caused by pressure of 
the uterus on the nerves of the leg or back, 
as the case may be; but cramps of the legs 
are much more common, and occur more 
often toward the end of pregnancy, when 
the child's head drops down into the pelvis. 
Cramps are also frequently accompanied 
by a numbness or tingling sensation. This 
trouble is best relieved by lying on the 
back with the hips raised, and by placing 
a pillow under them. 

Pigmentation, or liver spots, appear quite 
frequently during pregnancy. These yel- 
lowish or brown spots, the size of a dime or 
larger, may appear on any part of the body, 
but more frequently on the face, chest, 



m 



62 BEFORE THE BABY COMES 

breasts, and abdomen. These spots when 
they appear on the face are sometimes 
called the "mask of pregnancy." They 
are due to a deposit of iron in the skin 
when there is more iron in the blood than 
is required by the growing fetus. In fact, 
they are looked upon as one of the signs 
of pregnancy, such as the darkened area 
around the nipple, and the line down the 
center of the abdomen. Treatment will 
help very little, if at all. Certain outward 
applications may make the coloring slight- 
ly lighter. The spots usually disappear 
after the child is born. 

Falling of the hair is not so common dur- 
ing pregnancy as afterward. It occurs 
particularly in women of nervous tempera- 
ment. An iron tonic, preferably one pre- 
scribed by a physician, a shampoo every 
three or four weeks with tincture of green 
soap, and scalp massage every few days 
with a good tonic, will usually cause the 
hair to grow in thickly again. 

Longing and craving, or pining, as it is 
sometimes called, is an unnatural craving 
for certain kinds of food or abnormal 
desire for unusual things to eat, such as 



MISCELLANEOUS 63 

chalk, raw starch, slate-pencils, pickles, 
vinegar, raw vegetables, sweets, and other 
things. The desire for certain foods may 
be indulged in to a limited extent, pro- 
vided they are nutritious and not difficult 
to digest; otherwise these longings should 
not be gratified. Appetite for the unusual 
should be overcome as quickly as possible. 
This condition is almost entirely a nervous 
one which ceases at the birth of the child. 
Mental diversion and rigid self-control, 
with the usual careful attention to diet, 
will overcome the craving to a great extent. 
There is a popular superstition that if the 
mother's cravings are not satisfied the 
child will be marked. Of course this is 
nonsense. 

Loss of appetite may sometimes be com- 
plete, but more often it takes the form of a 
dislike or disgust for certain kinds of food. 
The cause also is a nervous one, due to ex- 
treme sensitiveness of the nerves of smell 
and taste. To overcome this choose, as 
far as possible, food that is appetizing. 
Sometimes a bitter tonic, such as extract 
of malt, will overcome this trouble. 

Pains in various parts of the body 



64 BEFORE THE BABY COMES 

are frequent during pregnancy — backache, 
headache, pains in the sides, the face, and 
so forth. These pains are usually due to 
rheumatism or neuralgia, which is very apt 
to appear at this period. They are some- 
times very stubborn and only disappear 
after confinement, but they are greatly 
helped and sometimes vanish completely 
if the bowels and kidneys are kept in good 
working order. 

Displacements. Forward displacements 
are quite common, and are one of the 
causes of painful menstruation; this condi- 
tion usually corrects itself when pregnancy 
takes place. In fact, pregnancy is one of 
the cures for displacements of this nature. 
Backward and downward displacements 
are the frequent causes of miscarriage, in- 
flammation, and sometimes of sterility. 
These displacements should be treated by 
a specialist, if possible. 

Shortness of breath is rather uncommon 
early in pregnancy, and when it occurs 
during the early months it is caused by in- 
digestion and gas, which may be overcome 
by dieting. This trouble is more common 
during the later months, and is caused by 



MISCELLANEOUS 65 

pressure of the womb on the diaphragm. 
It is also aggravated by nervousness and 
flatulence. The symptom is more uncom- 
fortable than alarming, and, since it is 
usually worse when lying down, some relief 
is obtained by being propped up with 
pillows. The clothing should be worn 
loose. Relief comes when the uterus sinks 
back into the pelvis, which is from two to 
four weeks before confinement. 

Excessive Saliva. This occurs occasion- 
ally with morning sickness. There may 
be only a slight but constant dribbling of 
saliva, or it may be very profuse and annoy- 
ing. This may be caused by nervousness 
or by indigestion. Attention to general 
health and to the diet and fresh air as sug- 
gested for nausea will be found helpful. 
Applications of heat to the cheek, near the 
ear, and frequent rinsings of the mouth 
with a saturated solution of chlorate of 
potash will give temporary relief. 

Maternal Impressions. From time im- 
memorial there has been a tradition that 
the unborn child is influenced by the moth- 
er's thoughts, emotions, and surroundings, 
and that it is marked by the mother's see- 



66 BEFORE THE BABY COMES 

dug unusual sights, deformities, and so 
forth. As yet there is no scientific proof 
that this is true, and the proofs offered of 
markings are merely those of coincidence. 
The favorite fallacies are that a strawberry- 
mark is caused by the mother's craving for 
strawberries; that moles and hairy patches 
are the result of the mother's fright over 
seeing a hairy animal, especially a mouse; 
that harelips and other deformities are 
caused by witnessing an accident. As ev- 
ery mother can recall some disagreeable 
physical or emotional experience during her 
pregnancy, and as no mother can hope to 
escape them, if these fallacies were true 
most children would be marked. As the 
child is fully formed by the end of the 
second month, it is impossible for any event 
that happens later to change it, and events 
that may happen before the second month 
are usually before most mothers are con- 
scious of or sure of their condition. It is 
quite within the limits of belief, however, 
that a woman may injure the fetus by 
attempts at abortion before the third 
month, thinking that life does not begin 
before quickening is felt. 



MISCELLANEOUS 67 

Painless Childbirth. Notwithstanding nu- 
merous advertisements to the effect that 
childbirth can be rendered painless by the 
use of certain drugs or by adhering to cer- 
tain diets, there is no such thing as painless 
labor or delivery, except when a mother is 
put under the influence of an anesthetic, 
and this is not always desirable or safe. 
The pains of a normal childbirth are due to 
the contractions of the uterus. These are 
necessary, as they furnish the propelling 
force that pushes the child through the 
birth-canal into the world. As a rule, the 
stronger these pains the more rapid the 
birth. When the muscles of the uterus are 
weak the pains are weaker and birth de- 
layed. Sometimes it is necessary to help 
by the use of instruments. 

A proper amount of exercise and a care- 
ful diet helps materially to make labor and 
childbirth normal and as nearly painless as 
possible. Certain books suggest diet and 
the use of oils to render labor painless. 
The diet is usually a dangerous one to 
follow. The use of oils externally does no 
harm, but it has no particular advantage 
other than adding to the mother's com- 



68 BEFORE THE BABY COMES 

fort for the time being by keeping the 
skin soft. 

Patent medicines should be avoided, as 
they frequently contain alcohol or narcotics, 
which may have a bad effect. Drugs and 
herbs advertised for this period are usually 
worthless, and may do harm by causing 
nausea. These should not be taken with- 
out medical advice. 



VI 

THE HYGIENE OF PREGNANCY 

PREGNANCY is a perfectly natural 
condition. It is also a period in a 
woman's life when she is undergoing most 
important changes; and while she should 
in no sense consider herself an invalid, it is 
a time when she can less afford to disre- 
gard the laws of health and hygiene than 
at any other period of her life. In order 
to carry her baby to full term, have a 
normal confinement, and give birth to a 
healthy living child, also to nurse it, she 
should endeavor to live as healthy a life as 
possible. The unavoidable complications 
of pregnancy are comparatively few. 

Exercise. Ordinarily there are no forms 
of exercise or home calisthenics which 
are to be recommended for this period; 
exercises previously practised should be 



7o BEFORE THE BABY COMES 

stopped and not renewed unless advised 
by a doctor. Massage should not be 
given to the abdomen, nor should it be 
rubbed hard, as this might start uterine 
contractions. If a woman has been living a 
normal, healthy life as regards exercise, 
diet, and habits, there is no reason why 
she should make any radical change in her 
mode of living. There is a strong tendency 
in many women, especially if young, to 
indulge in sedentary habits during preg- 
nancy. This is wrong; there should be 
occupation for both body and mind. 

Light housework is to be recommended as 
an excellent form of indoor exercise; it also 
diverts the mind. Hard work, such as 
large washings, scrubbing, much sweep- 
ing, lifting of heavy objects, carrying pails 
of water, and so forth, should not be at- 
tempted. Sometimes heavy domestic work 
is done without apparent harm, but it is 
attended with great risk, and if continued 
through several pregnancies usually ends 
in a breakdown and invalidism. Walking 
is one of the best kinds of outdoor exercise; 
walks of moderate length may be taken 
every day with decided benefit. Next to 



THE HYGIENE OF PREGNANCY 71 

walking is a drive over smooth roads in 
a carriage or automobile with good springs 
or a ride in a trolley-car. If, however, 
riding in any conveyance causes backache 
or a feeling of heaviness at the lower end 
of the spine it should be given up. Out- 
of-door sports such as riding horseback, 
tennis, golf, skating, swimming, and row- 
ing or paddling should not be indulged in. 
They are all more or less dangerous, as is 
anything that calls for sudden movements, 
jumping, jars to the body, also stretching. 
Dancing, running a sewing-machine unless 
it has a hand attachment, pedaling an 
organ or piano-player, reaching to light 
the gas when the fixture is beyond con- 
venient reach, lifting things from a high 
shelf, trying to raise a window that sticks, 
are all things to be avoided during preg- 
nancy. Ordinary reaching or sleeping 
with the hands above the head is harm- 
less. Household work, walking, and other 
forms of exercise should not be carried 
to the point of fatigue. 

Fresh air is especially necessary, as when 
it is breathed into the lungs it purifies the 
blood, which helps eliminate body waste. 



72 BEFORE THE BABY COMES 

Sometimes a woman is handicapped in her 
attempt to get into the fresh air. This 
may be during the early months when nau- 
sea and vomiting keep her in the house 
or from going far. Or it may be later in 
pregnancy when her increased size and 
heaviness make it inconvenient for her to 
walk or take much exercise. Sometimes 
a woman's house duties are so confining 
and tiring she cannot go out every day. 
Under these circumstances fresh air is 
more necessary than ever, and plenty of 
outside air should be let into the house. 
This is an easy matter in summer, when 
windows and doors are open and one can 
sit on the porch or lie in a hammock under 
the trees; but in winter, when the house is 
tightly closed, to get fresh air is a more 
difficult matter; the rooms are apt to be 
close, stuffy, and overheated, especially the 
kitchen or the general living-room. 

In these rooms a window should always 
be lowered from the top, if only for an inch 
or two, and in order to secure good circula- 
tion a window-board should be placed un- 
der the lower sash. It is well to spend 
an hour or two every day in a chair or on 



THE HYGIENE OF PREGNANCY 73 

the couch in front of an open window, in 
the sun if possible. One should be well 
wrapped, and the feet kept warm by a hot 
soapstone or some such thing. If a nap 
can be had at this time, so much the better. 
There should always be an open window 
in the sleeping-room at night. 

Recreation is as important as exercise and 
rest to the pregnant woman. Her mind 
especially needs diversion and pleasant oc- 
cupation. It is good for her to continue 
her social meetings, and to go to church 
and to interesting lectures, talks, and con- 
certs when opportunity affords. Her read- 
ing should be light and amusing. The 
kind that diverts the mind is much better 
than that which requires mental effort. 

Rest. All women who are pregnant re- 
quire a certain amount of rest. Early 
hours should be kept; it is desirable to 
have from eight to ten hours' rest at night. 
Even if all this time is not spent in sleep 
the rest in bed is beneficial. There is also 
at this time apt to be an overpowering in- 
clination to drowsiness and to tire easily. 
These calls for rest should be obeyed, 
especially when there are what is called 






74 BEFORE THE BABY COMES 

pressure symptoms, such as swollen feet, 
enlarged veins, palpitation, and shortness 
of breath. A short rest occasionally dur- 
ing the day of a half -hour or so is most 
beneficial. 

Food. The old saying that the pregnant 
woman ought to eat enough for two has 
been proved a myth. While an abnormal 
appetite is not at all unusual at this time, 
it has been shown that no more food is 
necessary during the pregnant state than 
was required to supply the needs before 
this time. Food taken in excess of the 
usual amount increases the size of both 
mother and baby. Women who eat very 
heartily and exercise little give birth to 
large children. The diet in general should 
be one that is nutritious, easily digested, 
and more or less laxative. There should 
be three regular meals daily, and it is well 
not to eat too heartily. Sometimes during 
the latter months of pregnancy there is a 
feeling of faintness and craving for food. 
When this is the case a cup of milk, malted 
milk, or broth with a cracker may be taken 
once or twice during the day, between 
meals or on retiring at night. As the first 



THE HYGIENE OF PREGNANCY 75 

process of digestion commences in the 
mouth, when the food mixes with the sa- 
liva, it is well to "Fletcherize," which is to 
eat slowly, and chew all food so finely that 
it is practically reduced to a fluid state be- 
fore swallowing. Tough parts that cannot 
be so reduced should not be swallowed, but 
rejected. 

By this method the process of diges- 
tion is well started before reaching the 
stomach, relieving it of much unnecessary 
work. As there is a tendency toward di- 
gestive disturbances at this time, it is well 
to avoid such foods as are known to dis- 
agree with one. It is also a good plan to 
rest for a short time after meals, and not 
to eat heavy meals at night. An excellent 
diet consists of meat that is lean and ten- 
der; fresh fish or salt codfish may be sub- 
stituted for meat several times a week if 
one so wishes; fresh vegetables, fruits, 
milk, cereals, eggs, and simple desserts. 

Among the meats the most nutritious 
are chicken, beef, mutton, or lamb. Those 
to be avoided as causing indigestion are 
fresh pork, veal, goose, and duck. As a 
rule, meats may be eaten once a day, un- 

6 



76 BEFORE THE BABY COMES 

less there is some complication that makes 
it necessary to restrict animal food. Veg- 
etables are strongly recommended, as they 
contain mineral salts needful at this time 
and aid in overcoming constipation. They 
are also nutritious. Most vegetables are 
good, but those of a starchy nature, such 
as potatoes, corn, and squash, should be 
eaten moderately. Vegetables that would 
better be excluded from the diet, as they 
produce flatulency, are cabbage, Brussels 
sprouts, cauliflower, turnips, parsnips, egg- 
plant, beans, radishes, and cucumbers. 
Ripe fresh fruits — apples, peaches, apri- 
cots, plums, grapes, oranges, and grape- 
fruit — are very good; also dried fruit like 
figs, dates, prunes, and tamarinds. Fruits 
act as a laxative, furnish mineral salts, 
help satisfy thirst, and diminish the crav- 
ing for sweets. The best time for eating 
fruits is before breakfast and before going 
to bed at night. 

Most cereals can be eaten at this time, 
but with the exception of rice it is well not 
to make them too great a part of the die- 
tary, especially during the last months, as 
an overabundance of starchy foods, also 



THE HYGIENE OF PREGNANCY 77 

sweets, taken by the mother is converted 
into fat in the child. A large child is not 
always desirable, especially if the mother 
is small or if a first pregnancy comes late 
in life. Rice makes an excellent substitute 
for potatoes and other starchy foods sever- 
al times a week during the latter part of 
pregnancy. As the child draws its nour- 
ishment at the expense of the mother's 
tissues, under normal conditions a mixed 
diet is best. Extremes in diet are not ad- 
visable, and one composed almost exclu- 
sively of vegetables, fruits, and water, or 
cereals is dangerous. 

Cravings and longings during pregnancy 
are not uncommon. They may be satisfied 
in moderation, provided the food craved 
is not indigestible or harmful. Abnormal 
desires for such things as chalk, raw starch, 
slate-pencils, pickles, and very sour things, 
or candy to excess should not be gratified, 
but every effort made to divert the mind 
and curb the appetite for these things as 
quickly as possible. This trouble is chief- 
ly a nervous one. 

A cup of cocoa between meals is helpful 
in producing milk. Tea and coffee should 



78 BEFORE THE BABY COMES 

be restricted to one cup of each a day, not 
strong. Cream should be avoided, except 
the small quantity used on the cereal or 
in tea or coffee. Rich foods, fried food, 
pastries, fresh or hot breads should not be 
eaten. 

Kidneys. Imperfect elimination of cer- 
tain waste-matter by the kidneys and the 
liver leaves a residue of waste-matter in the 
body which causes what is called auto- 
intoxication, or self - poisoning. This is 
one of the most dreaded complications of 
pregnancy. In order to detect these poi- 
sons and prevent, if possible, serious con- 
sequences, it is necessary that the urine 
be examined occasionally. During the first 
few months monthly examinations may be 
often enough; after the fourth month they 
should be made twice a month, or more of- 
ten if there is any indication of poisons. 

To obtain the best results the whole 
quantity of urine passed in twenty-four 
hours should be collected; from this fill a 
clean six-ounce bottle and send it to a 
physician, chemist, or laboratory that has 
had experience in urine analysis. It is 
important that the receptacle holding the 



THE HYGIENE OF PREGNANCY 79 

urine should be absolutely clean, and scald- 
ed well before using and kept in a cool 
place. In summer a teaspoonful of chloro- 
form added to the specimen will keep it 
from spoiling. The bottle should be la- 
beled with the name of the patient, the 
date, and total amount of urine passed in 
twenty-four hours. The presence of al- 
bumen, sugar, and certain acids which may 
point to serious trouble can only be deter- 
mined by a chemical analysis. Little can 
be determined from the appearance of the 
urine, as the presence of sediment or mu- 
cus which can be seen by the naked eye 
is not at all uncommon or of serious mo- 
ment. While no woman should miss these 
examinations if she can help it, to comfort 
those who cannot have them let it be said 
that comparatively few women who care 
for themselves properly at this time have 
kidney trouble. 

During the entire term of pregnancy it 
is well to drink considerable water, as it 
eliminates through the kidneys much 
waste that accumulates in the system. 
From six to eight glasses of water during 
the day is not too much. Begin the day 



So BEFORE THE BABY COMES 

by drinking one or two glassfuls before 
breakfast, two more between breakfast and 
the midday meal, two more between this 
and supper, and one or two the last thing 
before going to bed. The water should be 
cool, not iced. Lemonade may be substi- 
tuted for water two or three times a day if 
one chooses. 

About three pints of urine should be 
passed in twenty-four hours. If there is 
less than a quart passed, if it is very dark in 
color or pink, or a white powdery sediment 
settles after standing, drink freely of alka- 
line waters, such as vichy, seltzer, or lithia 
and weak lemonade without sugar. 

Bathing. The skin also has its share to 
do in eliminating waste-matter. This is 
done through the small sweat-glands, or 
pores, of the skin. Since the waste-matter 
is greater during pregnancy than before, 
bathing is most necessary, as it removes 
from the surface of the body the accumu- 
lated sediment from dried perspiration. 
In health the body throws off more than a 
pint of sweat daily. This is evaporated 
so rapidly that we are not conscious of it. 
It is only on hot days or from unusual 



THE HYGIENE OF PREGNANCY 81 

exercises, when a much larger quantity is 
thrown off, that we are sensible of it. 
Baths not only carry away this dried per- 
spiration, but also dried skin, dust, and 
germs ; they stimulate circulation by bring- 
ing the blood to the surface of the body, 
which helps to excrete the waste, 

Tub-baths are the best; when they are 
not to be had sponging off the entire body 
with water is the next best plan. The 
temperature of the water should be as near 
the body temperature as possible — about 
98 degrees. If one is accustomed to cold 
baths, and reacts well after them, they may 
be continued with discretion, but they are 
not to be generally recommended. After 
a bath the skin should be briskly rubbed 
with a coarse towel in order to stimulate 
circulation. Very hot baths or steam and 
vapor baths are depressing and should 
not be taken except when directed by 
a physician. Cold plunges, showers, or 
baths are likely to produce shock, which is 
dangerous at this time. Sea and surf bath- 
ing is not safe on account of shock if the 
water is cold, the danger of falls, and the 
strain of battling with the surf. Sitz-baths 



82 BEFORE THE BABY COMES 

are unnecessary, but may at times be at- 
tended with comfort, as when there is itch- 
ing or irritation from vaginal discharges or 
piles. 

Clothing. In selecting clothing during 
pregnancy there are three rules to keep in 
mind. First, that it should be of such 
material and style as to keep the body 
warm. Second, that it shall be loose 
and comfortable, not to constrict any part 
of the body. Third, that it should be of 
a style to make the woman as inconspicu- 
ous as possible. Warmth is especially nec- 
essary during pregnancy, as the slightest 
chilling of the body tends to check perspira- 
tion and throws the work the skin ought 
to do on the already burdened kidneys. 
Statistics show that complications of the 
kidneys are more common during preg- 
nancy in winter than in summer. Loose 
clothes are necessary because the internal 
organs of the body are already crowded by 
the enlarged uterus, and the added pressure 
of tight clothing on the chest or abdomen 
prevents full breathing and interferes with 
the proper expansion of the womb. Tight 
clothing also exaggerates the contour of the 



THE HYGIENE OF PREGNANCY 83 

form and makes a woman's condition much 
more conspicuous. 

During the first three months of preg- 
nancy it is not usually necessary to make 
a radical change in dress other than to 
loosen the clothing a little from time to 
time. It is well to select undergarments 
of materials that are light in weight but 
which contain some wool, as wool absorbs 
perspiration and prevents chilling of the 
body. Those of a ribbed weave are best, 
as they are more or less elastic and ad- 
just themselves to the figure with fewer 
wrinkles than any other kind. Union 
suits or separate shirts and drawers may be 
worn, but the latter are preferable, as the 
lower extremities often require additional 
warmth, and heavier drawers may be worn 
when necessary. In order that undervests, 
drawers, petticoats, and corset-covers may 
be comfortable and last until the end of 
pregnancy they should be, at the fourth 
month, several sizes larger than those usu- 
ally worn. Petticoats are easily adjust- 
ed to the changing figure if made a little 
large and with a draw-string or tape in- 
stead of a belt. Corset-covers should be 



84 BEFORE THE BABY COMES 

loose and adjusted at waist by draw-string. 
One-piece combination-suits or the Princess 
style of undergarments are not practical 
for maternity wear. 

It is not well to wear garters that en- 
circle the leg, as they interfere with the 
circulation and may cause varicose veins. 
Stockings should be fastened by a side- 
elastic to the corset or waist, and should not 
be tightly drawn. Shoes should be roomy 
and comfortable. High shoes that lace are 
to be preferred, as they will give support 
to the ankle. The heels should be moder- 
ately low and broad. Narrow, high heels 
should never be worn, as they throw the 
body forward, causing backache on account 
of the strain on the muscles of the back. 
They may also cause the ankles to turn, 
and a fall may follow with serious conse- 
quences. For outside clothing one-piece 
gowns are to be preferred to separate skirt 
and waist, as the latter are apt after a 
while to gape at the waist -line. Very 
heavy skirts should not be worn. One- 
piece gowns and skirts are now made with 
adjustable arrangement, by which they can 
be enlarged from time to time as the needs 



THE HYGIENE OF PREGNANCY 85 

require. Such garments can be bought 
from maternity outfitters or made at home 
from special patterns designed for the 
purpose. 

Corsets. As long as corsets are loose, 
enough and perfectly comfortable there 
is no objection to their being worn dur- 
ing the early months of pregnancy. They 
should then be discarded and a maternity 
corset worn instead. The best maternity 
corsets are those which support the breasts 
without much pressure upon them and fit 
snugly around the hips and under the 
abdomen, making an upward pressure. 
These corsets can usually be worn to 
within a short time of confinement. It 
should be remembered that corsets of this 
kind are not worn for the purpose of re- 
ducing the figure, but for support and 
comfort. Some women have never been 
in the habit of wearing corsets. Where 
this is so there is no necessity of putting 
them on now; they will probably be more 
comfortable without them. 

Breasts. The old-fashioned method of 
applying alum, alcohol, whisky, cologne, 
tea, or other astringent lotions to the 



86 BEFORE THE BABY COMES 

breasts with a view of making the nipples 
tough and hard is a mistaken one. This 
so-called hardening process, if practised to 
any extent, will cause the nipples to be- 
come so dry that they are likely to crack, 
and fissures form which may become 
infected and result in abscesses. Some- 
times as early as the fourth month there 
is a discharge from the breasts. As soon 
as this occurs, whether earlier or later in 
pregnancy, the breasts should be bathed 
frequently; if allowed to dry and form 
crusts the nipples will become irritated 
and sore. It is best to keep the nipples 
covered with small folds of clean, old 
linen or gauze; if the discharge dries on the 
clothing these places, when dry, become 
stiff and add to the irritation of the nip- 
ples. During the last three months of 
pregnancy wash the breasts thoroughly 
night and morning with warm water and 
Castile soap, after which gently rub with 
olive-oil, cold-cream, vaseline, or a mix- 
ture of lanolin one part and cocoanut-oil 
two parts. If the breasts become heavy 
support them with a broad bandage or 
breast-binder. Sometimes tight clothing 



THE HYGIENE OF PREGNANCY 87 

or corsets pressing upon the breasts cause 
the nipples to become flat. In this case 
the pressure should be removed and the 
nipples twice a day rubbed with oil and 
pulled out. 

Traveling. Unless necessary it is best 
not to take long railroad journeys. Travel- 
ing by boat on smooth water is safe, but 
ocean or lake travel is somewhat risky on 
account of the possibility of seasickness 
and the strain of trying to keep in the 
berth in rough weather. Women who mis- 
carry easily should not travel during the 
first four months nor during the seventh 
month; neither is it wise to travel on 
menstrual dates. When the road-bed is 
smooth and cars are comfortable, traveling 
on railroads is usually attended with little 
danger. 

The Marital Relations. It is generally 
believed by physicians that the marital 
relations should be restricted during preg- 
nancy, especially at menstrual dates. 
Neglect to practise moderation in this re- 
spect is a common cause of abortion and 
premature birth. 



VII 

PREPARATIONS FOR CONFINEMENT 

AS soon as pregnancy is assured it is 
L best for a woman to begin prepara- 
tions for her confinement by finding out 
from her physician the probable date of her 
delivery and engaging his services for that 
event. Then it is well to look about for a 
competent nurse and engage her, and if 
possible get in touch with one or more 
nurses who can be called upon in case of 
emergency, such as premature birth, when 
the nurse engaged may not be available. 

If one's means allow it is advisable to 
have the nurse come a few days in advance 
of the supposed date of confinement. It 
will be a comfort to the mother to feel that 
there is an experienced person at hand who 
will know when to call the doctor and to 
prepare the room and the patient. While 



PREPARATIONS 89 

waiting, the nurse can prepare and steri- 
lize the dressings, as well as make herself 
useful in many little ways. A nurse is 
always paid from the time she is engaged 
whether she is called to the house or not, 
as it cannot be expected that she should 
remain idle without recompense. 

Cleanliness of the room, the bed, and the 
patient are most necessary at the time of 
confinement. The room should be clean, 
light, well ventilated, and heated if the 
weather is cold. Hard-wood or painted 
floors are the most sanitary. If the floor 
is carpeted the carpet should be gone 
over with a wet cloth wrung out of a 
disinfectant. All around the bed the car- 
pet should be covered with several layers 
of newspaper; over these tack old sheets. 
The bed should stand out in the room, so 
that the doctor and the nurse can pass on 
either side of it, and should face the light 
if possible. The mattress should be firm, 
smooth, and not hollow, or sag in the 
middle. If the springs are not strong or 
level enough to keep the mattress from sag- 
ging a board should be placed across the 
springs beneath the mattress. An ironing- 



9 o BEFORE THE BABY COMES 

board or table-boards may be used if 
nothing else is available. A single bed or 
cot is best for confinement, and it is much 
easier for the doctor to deliver the woman 
if the bed is raised from the floor a foot or 
more by placing blocks of wood under the 
bedposts. 

The bed should be prepared as follows: 
Across the center of the bed stretch 
rubber sheeting at least one and one-half 
yards wide and long enough to tuck in on 
either side; also pin it to the side of the 
mattress with large safety-pins to keep it 
from slipping. Over this place the clean 
sheet, which should be large enough to tuck 
well in at the sides and both ends of the 
bed. Across the bed where the hips rest 
stretch a sheet, folded lengthwise about a 
yard wide; between the folds of this place 
a square yard of rubber sheeting, enamel 
cloth, or several thicknesses of stout paper. 
This is called the draw-sheet, and must be 
stretched tightly across the bed and pinned 
firmly with large safety-pins. This can be 
removed after confinement, leaving a clean, 
dry bed for the patient to lie on. The top 
covering may consist of a sheet or a sheet 



PREPARATIONS 91 

and blanket, according to the temperature 
of the room. One or two pillows may be 
used, as the patient prefers. The following 
articles should be ready at the time of 
confinement : 

From one-half to a dozen clean sheets. 

One dozen or more sterilized towels 
for the doctor's use — soft, old ones are 
best. 

Six delivery-pads made of coarse cheese- 
cloth, filled with cotton or new cotton 
waste, which has been made absorbent 
and soft by boiling in water with wash- 
ing-soda in it. Cotton waste is much less 
expensive than cotton. The patient's 
thighs rest on these pads during delivery; 
as soon as one becomes much soiled it 
should be replaced by a fresh one. 

Five or six dozen sanitary pads for use 
after confinement may be bought at a 
moderate cost, or made at home of cheese- 
cloth filled with cotton or cotton waste. 
They should be ten inches long, three or 
four wide, and are held in place by a 
T-bandage. 

Three abdominal binders made of stout 

7 



92 BEFORE THE BABY COMES 

unbleached muslin one and one-quarter 
yards long and one-half yard wide. 

A piece of rubber sheeting or enamel 
cloth one and one-half yards wide and long 
enough to stretch across the bed and tuck 
in. Also a piece one yard square. 

One fountain syringe. 

One douche-pan. 

A cake of soap and a six-ounce bottle of 
tincture of green soap. 

A jar of vaseline. 

A piece of linen bobbin or narrow tape 
one-sixteenth of an inch wide and a yard 
long for tying the cord. 

A pair of sharp scissors for cutting the 
cord. 

A package of squares of old linen or 
gauze, sterilized, for dressing the cord. 

A pound of sterilized absorbent cotton. 

A quart of boric-acid solution 1 in a clean 
stoppered bottle, and two or three small 
dishes or bowls to hold some of the solution 
when needed. 

A pail or basin, under the bed, to hold the 
afterbirth. 

1 One teaspoonful of boric acid to one pint of boiled 
water. 



PREPARATIONS 93 

Two clean agate basins. 

Two slop-jars. 

Two agate pails, one full of very hot 
water, and one for cold water that has 
been boiled. 

Fifty bichloride-of-mercury tablets, for 
making a solution of 1-1000. These are 
poison and should be labeled poison and 
carefully guarded as such. 

The making of dressings may be done 
by the mother at odd moments, or by the 
nurse if she is in the house. They may 
be sterilized also at home or at a near-by 
hospital for a small consideration. Many 
druggists also keep sterilized obstetrical 
packages, the expense varying according 
to the number of dressings required. There 
are two methods of sterilizing at home — 
dry heat and moist heat ; the latter method 
is surer. Towels, sanitary napkins, pads, 
and gauze or linen squares should be tied 
up in packages of six each, and each pack- 
age wrapped in squares of unbleached or 
clean, old muslin, pinned securely, and the 
nature of its contents marked on the out- 
side with pencil or ink. The small pack- 
ages may be wrapped together in another 



94 BEFORE THE BABY COMES 

bundle to keep them together. These can 
be dry-sterilized by putting them in a 
rather slow oven until the covering is 
scorched a light russet brown. To steri- 
lize by moist heat use a wash-boiler in 
which there are two or three inches of 
water. Take a strip of muslin an inch or 
two narrower than the width of the boiler 
and fasten it to the handles so the muslin 
forms a sort of swing or hammock. Place 
the bundles inside this hammock, cover 
the boiler, and let the water boil for a 
good half-hour. The hot steam rises, 
penetrates the bundles, and sterilizes the 
contents. After the steaming place the 
bundles in a wire drain, resting on bricks 
on the back of the stove, to dry out. All 
sterilized bundles should be put in a 
clean box and laid away unopened until 
needed. Nail-brushes, scissors, and bob- 
bin should be boiled in a basin during 
labor, and not taken from the water until 
used. 

The point to keep in mind in preparing 
the room for confinement as well as sup- 
plies and dressings is : absolute cleanliness 



PREPARATIONS 95 

and freedom from germs. "Blood-poison- 
ing and childbirth fevers come from in- 
fection by germs. For this reason the 
furniture of the room should be limited to 
necessities, and there should be no need- 
less hangings or ornaments to collect dust. 
The bed, two or three chairs, a table for 
dressings and other things to be used during 
delivery, and another table for wash-bowl, 
pitcher, and towels, are all that need be in 
the room. Woodwork in the room and 
furniture should be wiped off with a dis- 
infecting solution, and the tables covered 
with sterilized towels or sheets. The bed- 
clothes and clothing worn by the patient 
during confinement are practically sterile 
if washed clean, boiled, and dried in the 
sun and ironed. This can be done a few 
days before confinement is expected, and 
the clothing put away for use when the 
time arrives. Dressings must be more 
carefully sterilized, as the birth canal is, 
to all intents and purposes, an open wound 
for several days after delivery and must 
be treated as aseptically as a wound. 

A woman about to bear her first child is 
naturally anxious to know at what time she 



9 6 BEFORE THE BABY COMES 

should call the doctor or the nurse. With 
her, labor does not proceed as rapidly as 
with those who have previously borne 
children, so there is no need for excitement 
or fear that the doctor will not arrive in 
time. Usually it takes from six to eight 
hours or even longer from the time of the 
first pains until the womb is fully opened 
for the child to pass out. The time may 
be much shorter for women who are al- 
ready mothers, especially where they have 
good muscles, a large pelvis, and are in- 
clined to quick labor. When this is the 
case the doctor should be informed in ad- 
vance, and a hurry-call sent in on the first 
intimation of labor pains. 

The first signal that pregnancy is ap- 
proaching its termination is when the womb 
vSinks down in the pelvis. This is from 
two to four weeks before the onset of labor. 
There will be noticed a feeling of relief 
from pressure, the abdomen appears flatter, 
and the breathing becomes less hampered. 
The desire, experienced in early pregnancy, 
to pass the urine frequently, reappears. 
There may also be pains in the legs and 
some added difficulty in walking. There 



PREPARATIONS 97 

is sometimes a discharge of mucus from 
the vagina, but this does not mean the 
approach of labor, and is quite different 
from the watery discharge caused by the 
rupture of the bag of waters. 

As soon as there are signs of approaching 
labor a full warm bath should be taken, 
the genitals being thoroughly and care- 
fully washed; also, a soap-suds enema 
should be given to prevent unnecessary 
obstruction to the passage of the child or 
the possibility of a stool in the bed during 
confinement, with danger of infection. 
Pressure on the bladder will make it neces- 
sary to pass urine frequently, and each 
time it is done the genitals should be 
washed. A freshly laundered union-suit of 
knitted ribbed underwear, old or new, is 
the most comfortable garment to wear 
during confinement. It can be cut up the 
back and pinned together in order to make 
its removal easier after the baby is born. 
It keeps the body warm and prevents 
undue exposure during delivery. Long 
stockings may be worn to keep the legs 
and feet warm, and a nightgown if de- 
sired. This should be short, reaching 



9 8 BEFORE THE BABY COMES 

about to the knees, and open down the 
front. 

Pains in the back or in the lower part of 
the abdomen are signs of the first stage of 
labor. They may be preceded by a dis- 
charge of blood or a watery fluid. Then 
come the pains at intervals as the womb 
contracts in its efforts to expel the child. 
These last until the neck of the womb is 
dilated sufficiently to permit the child to 
pass through. During these pains the 
waters are forced downward and, by push- 
ing against the narrow neck, act as an 
opening-wedge, the bag breaks, and the 
waters escape a little before the neck is 
completely dilated, or at the second stage 
of labor. Sometimes the water breaks 
several days before labor. This causes 
what is called a dry birth. 

Occasionally pains similar to these de- 
scribed may appear several days or weeks 
before real labor; these are false labor 
pains, but the only way to know that they 
are false is by the doctor's examination 
and the fact that they tend to come 
stronger and quicker than the real pains. 
Also, if the hand is placed on the abdomen 



PREPARATIONS . 99 

during real labor pains the uterus can be 
felt to contract and grow hard, while 
between pains it softens again. 

When the first pains come on the physi- 
cian should at once be notified. As this 
stage is usually a long one, he may not 
think it necessary to call at once, or he 
may come and examine the patient and 
leave instructions with nurse or attendant 
to be called at a certain time or to have the 
progress of labor reported. In the mean 
time there is usually no necessity for the 
patient to go to bed. Between pains she 
may rest by lying down if she chooses. 
Otherwise she will find that walking about 
or employing herself with some light house- 
work will divert her mind from her pains. 
These are sometimes made less trying by 
leaning oyer the foot of the bed or the back 
of a chair. Broths may be taken from 
time to time, and the patient may have all 
the water she wishes to drink. As said 
before, there should be no straining during 
the first stage of labor. It does not help 
the progress of the child, and it exhausts 
the mother's strength. When the inter- 
vals between pains become short, about 



ioo BEFORE THE BABY COMES 

five minutes apart, or the pressure of the 
head causes the parts about the vulva to 
enlarge, it is time to put the patient 
to bed, and the doctor should be again 
notified, as the second stage of labor is at 
hand. 

The abdominal muscles now contract, 
naturally, when the pains come on and com- 
bine with the uterine contractions to expel 
the child. Straining at this time is a re- 
lief to the patient. She will also find re- 
lief by bracing her feet against the foot of 
the bed and pulling on a band of muslin or a 
sheet attached to the bed. If the pains are 
very severe chloroform is sometimes given 
to lessen the consciousness of them, but 
chloroform should always be given by a 
physician or a trained attendant under his 
supervision. When given under any other 
conditions a great risk is assumed. The 
second stage of labor ends with the expell- 
ing of the child. 

The third stage is where the afterbirth, 
or placenta, comes away. This is usually 
from fifteen minutes to half an hour after 
the birth of the baby. It is while waiting 
for the afterbirth that the physician usu- 



PREPARATIONS 101 

ally sews up any small tears that may 
have occurred; at this time the parts are 
still numbed by the pressure during birth, 
and the repairs can be done with little 
inconvenience to the patient. Perineal 
lacerations do not always occur, but when 
they do it is usually because it was un- 
avoidable. It is best that they should be 
attended to at once, unless the laceration 
is extensive, when it may be wiser to wait 
until later. Occasions for delay, however, 
are rare. 

The Unforeseen. The unforeseen will 
often happen. Sometimes the doctor is de- 
layed in reaching the patient, or the baby 
may come earlier than expected and before 
doctor and nurse arrive. Some families 
live in remote districts where it is not 
uncommon for women to give birth to 
babies with no other assistance than that 
given by a neighbor or by some member 
of the family. Under these circumstances 
it is well for some one to know what to do, 
and more especially what not to do. In the 
first place, as has been previously said, 
there must be absolute cleanliness of the 
patient, the room, the bedding, the cloth- 



102 



BEFORE THE BABY COMES 



ing, and the hands and clothing of the 
person or persons assisting. Everything that 
comes in contact with the woman during 
delivery must be clean. If there is a chance 
of the doctor arriving within a reasonable 
time it is well to keep the patient in bed 
instead of walking about, as this will 
sometimes delay labor a little. When the 
pains are coming at five-minute intervals 
put her to bed. Previous to this the 
bladder and the rectum should be emptied, 
but it is not well for her to remain on the 
toilet too long or to strain in trying to pass 
urine, for if labor is easy and rapid the 
child may be born at this time. 

Have the patient lie on her back, with 
knees drawn up and spread apart. Then 
let nature take its course. Don't interfere. 
When the baby is born if it does not cry 
out give it a few quick slaps on its back, or 
slap it with the end of a wet towel several 
times on the chest and back until it does 
cry out. Then wipe the mucus from its 
mouth with a piece of gauze wound around 
the little finger and wet with the boric-acid 
solution. At the same time wash out the 
nose, and with separate bits of cotton 



PREPARATIONS 103 

wash around the eyes. Then, opening the 
lids with thumb and forefinger, dip a 
fresh bit of cotton in the boric acid and let 
several drops from the wet cotton fall 
into the eyes. There is no danger of get- 
ting too much of this solution in the eyes. 
It is harmless, cleansing, and a mild dis- 
infectant. Now cover the child with a bit 
of blanket, and lay it near its mother to 
keep warm. 

Do Not Hasten to Cut the Cord. Keep 
the forefinger on it, and when it ceases to 
pulsate, then with the sterile tape tie the 
cord tightly three inches from the navel; 
then make a second tying an inch beyond 
the first. Between these two cut the cord, 
using a pair of sharp scissors which have 
been previously boiled and not removed 
from the water until used. Dust the 
navel cord with a little boric-acid powder 
and cover it with a piece of sterilized 
gauze. A drop or two of blood will prob- 
ably ooze from the cord when cut, but if 
the bleeding continues the string is not 
tied tight enough, and the cord should be 
tied again a little nearer the navel, but do 
not disturb the first tape. 



io 4 BEFORE THE BABY COMES 

If the afterbirth is slow in coming do 
not try to hasten it by pulling on the 
navel string or cause its expulsion in any 
way. Cover the genitals with a gauze 
pad wrung out of a disinfectant and wait 
for it to be cast off. Now place the hand 
over the mother's abdomen until the upper 
part of the uterus is felt a little below the 
navel, and hold it firmly for about an hour. 
If there is much bleeding cold applications 
over the uterus will help control it. 
There is always considerable bloody dis- 
charge right after the birth, but it should 
not continue for a long time. The external 
parts should be carefully bathed with an 
antiseptic solution. First wash the pri- 
vate parts, then the thighs and buttocks. 
After this replace soiled pads, gown, and 
sheets by fresh ones, and place a sterilized 
pad over the parts. 

If the measures already described do not 
revive the child and cause it to breathe and 
cry out, after the cord is cut dip the baby 
several times and quickly in a tub of cold 
water, as cold as it runs from the faucet. 
From the cold water put the baby in a tub 
of warm water for a few minutes, then 



PREPARATIONS 105 

back again into the cold water; this may 
be done several times. Artificial respira- 
tion should also be tried. As soon as 
breathing is established wrap the child in a 
warm blanket and keep it warm by placing 
it close to its mother or by putting hot- 
water bags around it — but not so near that 
there is danger of burning it. 

Hospitals. The hospital as a place of 
confinement offers several advantages over 
the home, and when one counts the cost 
of surgical supplies, the salary of a nurse, 
her board and washing, it is, on the whole, 
less expensive. At the hospital there is 
everything on hand for an emergency, 
surgical asepsis is more possible, and it 
affords a rest and quiet not always pos- 
sible at home. The hospital is especially 
to be recommended under the following 
conditions : 

To those who live in cramped quarters 
and small apartments. 

Where there is a possibility of abnormal 
births. 

Women who live in isolated places 
where good medical attention is impos- 
sible. 



106 BEFORE THE BABY COMES 

To women who bear their first children 
when past the age of thirty. 

Midwives are fairly trustworthy if they 
hold a diploma from a licensed school of 
midwifery, have a good record for care- 
fulness and cleanliness, and are competent 
enough to know when the birth is not 
normal and call in a physician. 



VIII 

THE LYING-IN PERIOD 

AFTER the birth of the child, and as 
A soon as the mother has received the 
proper attention as described in the last 
chapter, she should be made comfortable 
by darkening the room and being dis- 
turbed as little as possible. A cup of hot 
broth or milk may be given her to refresh 
her after the exhaustion of labor. Quiet 
and sleep are very necessary, and no one 
should be admitted to the room for twenty- 
four hours, excepting the immediate mem- 
bers of the family, provided she wishes to 
see them, and these only for a few minutes. 
If the delivery has been particularly ex- 
hausting even the family should be ex- 
cluded. Other visitors should not be per- 
mitted until the patient is up and about 

the room. 

8 



io8 BEFORE THE BABY COMES 

The sanitary or sterile napkin should 
be changed every four or five hours; also 
whenever the patient urinates or has a 
stool. Every time it is changed the parts 
should be washed off by pouring over them, 
from a pitcher, a disinfecting solution, the 
flow running off into a bed-pan placed 
beneath the buttocks. If the napkins be- 
come soaked they must be changed more 
often. 

The discharge following childbirth is 
called lochia, and should be carefully 
watched during the entire lying-in period. 
This discharge may be quite profuse during 
the first twenty-four hours without mean- 
ing anything unfavorable, but if it is very 
severe it is best to be on the safe side and 
notify the doctor. The flow should con- 
tinue to diminish daily and change in 
color from a bright red to a thin brownish 
discharge. It usually lasts about two 
weeks, sometimes longer, especially in 
women who have had children, in those 
who do not nurse their babies, and in those 
who get up too early and do heavy work. 
In the latter instance it may last six weeks, 
but this is an abnormal condition, and the 



THE LYING-IN PERIOD 109 

doctor should be consulted, as rest and 
treatment are required. 

The temperature should be taken twice 
a day for at least a week and anything 
over 100 degrees reported to the doctor at 
once, as even a slight fever during the first 
week may indicate blood-poisoning. The 
danger of such an occurrence, however, 
may be entirely avoided by absolute clean- 
liness during confinement and in caring 
for the patient afterward. 

For the first few hours after delivery the 
head should be kept low. The abdominal 
cavity being suddenly relieved from pres- 
sure of the enlarged womb, the veins at 
once begin to dilate, and the blood rushes 
in to fill them; at first this may be too 
rapid and take too much blood from the 
brain. In a few hours, however, the circu- 
lation adapts itself, and the danger is over. 
Then the patient can have a pillow. Dur- 
ing the first two or three days it is best to 
lie on the back as much as possible if it 
does not cause too much discomfort. 
When necessary to turn on the side it is 
well to keep the legs extended and not to 
draw them up. 



no BEFORE THE BABY COMES 

After the third day the patient may lie 
in any position she finds most comfortable. 
If she finds it more comfortable to lie on 
the stomach, so much the better, since it 
tends to prevent backward displacements. 
She may now commence to sit up in bed, 
propped by pillows, but she should not 
get up until the uterus has receded into 
the pelvic cavity so that it cannot be felt 
by external examination, which is usually 
from two days to two weeks. At the end 
of this time the mother may sit up in a 
comfortable chair and walk about the 
room a little, but should go to bed or lie 
on a couch as soon as she feels the slightest 
fatigue. About the third week, provided 
everything has progressed favorably, she 
may go out for a short walk or drive, but 
she should not attempt household work, 
do any lifting, go up and down stairs more 
than once a day, or stand long at a time, 
until the end of six weeks. It takes at 
least this length of time for the womb 
to get back to its normal size and position 
in the pelvis. Heavy work (such as wash- 
ing, scrubbing, sweeping, lifting) if at- 
tempted too soon after confinement causes 



THE LYING-IN PERIOD in 

displacements or falling of the womb, 
especially if there has been a tear in the 
pelvic floor. 

An abdominal binder is usually applied 
after delivery for the purpose of pressure 
on the womb, thus stimulating contrac- 
tion. It should be applied tightly to 
serve this purpose, and it is not necessary 
after the first twenty-four hours unless the 
patient feels more comfortable with the 
support. In this case it should not be 
pinned too tightly, as it may do harm by 
causing a backward displacement. As 
soon as the patient is able to be on her 
feet, if she has been accustomed to wearing 
corsets she should wear a well-fitting one, 
as a corset that presses the abdominal 
contents downward is bad. Douches, un- 
less ordered by the doctor and supervised 
by an experienced person, should not be 
given. 

The Bladder, There is usually some 
difficulty experienced in passing urine for 
a day or two after confinement. The 
compression during pregnancy and the un- 
usual pressure during delivery cause the 
bladder tissue to lose its normal tone for 



ii2 BEFORE THE BABY COMES 

a short time. It may eventually be neces- 
sary to draw away the urine by means of 
a catheter, but this should not be done 
until at least twelve hours have passed 
and every effort has been made to stimu- 
late the bladder to action by the applica- 
tion of cloths wrung out of hot water over 
the bladder and genitals, or by alternating 
cloths wrung out of hot and cold water. 
An injection of hot water into the rectum 
or the sound of water running from the 
faucet are things to be tried and repeated 
at intervals. If after twelve hours these 
fail, which they rarely do, the catheter 
will have to be used by the physician or 
a competent nurse. The patient may be 
allowed to sit in an upright position for a 
short time on the bed-pan, but this is to be 
avoided if possible for the first three days. 
Bowels. At the end of forty-eight hours 
after confinement a laxative should be 
given. Castor-oil in one or two table- 
spoonful doses is a favorite, because of the 
stimulating effect it is supposed to have 
on the milk secretions. If it is difficult 
to have a movement an enema of two or 
three ounces of olive-oil may be given, 



THE LYING-IN PERIOD 113 

especially if there has been a perineal tear 
which is sewn up. There is apt to be con- 
stipation during the lying-in period on 
account of the relaxed condition of the 
abdominal walls, lack of exercise, and 
tenderness about the rectum. Laxative 
foods should be taken, or a mild laxative, 
such as cascara sagrada, in small doses of 
from ten to twenty drops three times a day. 
After a while the doses may be gradually 
diminished. Enemas may be occasionally 
necessary. 

The Breasts. Before and after each nurs- 
ing the nipples should be washed with a 
saturated solution of boric acid; between 
nursings it is well to have the nipples 
smeared with vaseline clean from the tube, 
or cocoa-butter may be used. Keep them 
covered with a piece of sterile gauze. 
Frequently during the early weeks follow- 
ing confinement the breasts will secrete 
more milk than the baby is able to take, 
and the milk if allowed to remain in the 
breasts will cause them to become dis- 
tended and painful. Sometimes they be- 
come hard and lumps form. To prevent 
this condition the residue of milk should be 



ii 4 BEFORE THE BABY COMES 

taken away by gently stroking the breast 
toward the nipple, taking it between the 
thumb and fingers, or by the use of a 
breast-pump. A breast-binder, so adjust- 
ed as to cause uniform pressure around 
the breasts, is also good to relieve the con- 
dition. Uniform pressure may ordinarily 
be obtained by tucking wads of cotton 
under the binder, between the breasts, 
about them, and under the arms. When 
the breasts become hard or have lumps, 
cloths wrung out of hot water and wrapped 
around them will frequently give relief. 
The mother should take less liquid, and a 
dose of salts to give a watery movement. 
As she returns to her usual active life, and 
the baby grows stronger and correspond- 
ingly hungry, this condition will correct 
itself. 

The mother's diet for the first day after 
confinement should be milk and broths. 
On the second day toast, eggs, and a 
cereal may be added. On the third day, 
provided there is no fever and that she 
has had a free movement of the bowels, 
she may have a dinner of meat, vegetables, 
and dessert. It is a mistake to think that 



THE LYING-IN PERIOD 115 

unusual or rich foods, cream, beer, ale, or 
porter must be taken at this time to in- 
crease the milk. When this is done it is 
more than likely to result in the mother 
growing stout and the . milk decreasing, 
usually disappearing entirely. Under or- 
dinary conditions a woman may eat any- 
thing that agrees with her. A good general 
diet consists of soups, meat once or twice 
a day, and fresh vegetables; when the 
latter are not in season good canned ones 
may be substituted, and fruit, oysters, fish, 
eggs, and wholesome desserts. Foods that 
cause flatulence and indigestion have to 
be avoided. They are listed in the chap- 
ter on "The Hygiene of Pregnancy.' ' 

A cup of cocoa or a bowl of thin, well- 
salted yellow corn-meal gruel will be found 
excellent to increase the flow of milk; it 
also acts as a laxative. Tea and coffee 
may be drunk moderately — that is, one 
cup of each a day. Tea causes constipa- 
tion in both mother and child, and causes 
the milk to become so thin that it furnishes 
little nourishment for the child. A nurs- 
ing mother should drink plenty of water. 

Deficient milk secretions may be due to 



n6 BEFORE THE BABY COMES 

any of the following causes : lack of gland- 
tissue, poor health, age, obesity, overwork, 
nervousness, worry, or previous disease of 
the breasts. 

Leaking breasts are not uncommon, and 
when this condition exists it is a difficult 
one to check. The breast-binder, to give 
support and even pressure, with occasional 
doses of salts, will do much to check the 
flow, especially if it be from an over- 
abundant fullness of the breasts. When the 
cause is anemia or ill health it is best to 
wean the child, as the condition is weak- 
ening. 

Sore nipples axe usually due to neglect 
in caring for the breasts during pregnancy; 
the care of which has already been de- 
scribed. 

Abscess of the breast is more likely to 
occur in women who are nursing their 
first baby. It is usually due to an in- 
fection of some kind which enters through 
a crack or abrasion of the nipple, or the 
child's mouth may be the source of infec- 
tious germs. An abscess begins with a 
hard, tender swelling which soon becomes 
red, accompanied at times with fever, 



THE LYING-IN PERIOD 117 

chills, and general prostration. It is best 
to send for the doctor, as the earlier the 
abscess is opened the less harm will result 
to the breast. It is a mistake to allow the 
abscess to go until it breaks spontaneous- 
ly or] opens itself. When convinced that 
there is an abscess, not merely a caked 
breast, it is best to take the child from the 
breast, support the breasts with a binder, 
and keep cold applications over the in- 
flamed area. 

The Baby. After the cord is cut, the face 
washed, the mouth and the eyes washed out, 
cover the body with vaseline or olive-oil. 
This removes the cheesy matter which 
usually covers a part if not all of the baby's 
body. Now wrap the baby in a warm 
blanket or shawl and put him in a basket 
or a crib in a warm place, out of the way, 
until the mother's needs are attended to. 
The baby should be well covered, head and 
all, a small opening being left for breath- 
ing. It must be remembered that the baby 
has just come from a much warmer nest 
than the room temperature and feels the 
difference keenly ; it is probably the sudden 
chilling that makes it cry out at its birth. 



n8 BEFORE THE BABY COMES 

To prevent inflammation of the eyes 
through possible infection during its pass- 
age through the birth-canal a drop or 
two of a one-per-cent. of nitrate-of -silver 
solution should be dropped into each eye, 
then immediately washed out with the 
boric-acid solution. This is very impor- 
tant. Not having the eyes properly at- 
tended to at birth is a common cause of 
blindness. 

As long as the baby is kept warm there is 
no need of hurry in the matter of bathing 
it. It will do no harm to let it lie six or 
eight hours if necessary. First see that 
the mother is made comfortable, the room 
made tidy, and that soiled pads and dress- 
ings are taken away; then begin to get 
things ready for the bath. Place within 
easy reach two basins of water, one for 
washing and one for rinsing the body. Use 
a large flannel apron or a blanket in which 
to wrap the baby, and keep him covered 
while bathing. Bathe him in front of the 
fire or near a radiator. The temperature 
of the room should be between 70 and 75 
degrees for this first bath. The tempera- 
ture of the water should be between 98 



THE LYING-IN PERIOD 119 

and 100 degrees. Keep the baby under 
cover of the blanket, and bathe with as 
little exposure as possible, taking only a 
small portion of his body at a time — first 
the head and face, then the arms, one at 
a time, next the chest and the abdomen. 
Then roll him over and wash his back and 
buttocks. Lastly, wash his legs, uncover- 
ing but one leg at a time. Be sure, how- 
ever, to wash between all creases of the 
skin and remove all cheesy matter which 
may be there. Dry him with a soft 
towel. The baby should be bathed in this 
manner every day until the cord drops off. 
Then he should have a tub-bath every day. 

Premature or very feeble children should 
not be bathed in water, but rubbed in oil 
and wrapped in cotton-batting, kept in 
place by winding a gauze bandage around 
the body and around each arm and leg. A 
little coat made of cheese-cloth, with cheese- 
cloth shoes and stockings attached, all lined 
with cotton, will keep its place on the child. 

The cord should be dressed every day 
with a square of sterile gauze or clean linen, 
and a powder made of equal parts of burnt 
alum and bismuth dusted on it. The 



i2o BEFORE THE BABY COMES 

gauze or linen should be four inches square 
with a small hole cut in the center. Put 
the cord through this hole, dust on the 
powder, and fold the sides of the square 
neatly over the center. The baby's band 
will hold the dressing in place. It is better 
not to wash the cord, which usually comes 
off by the end of the first week — sometimes 
a few days earlier or later. When it comes 
off the navel is still a little moist and raw 
and should be dusted with the powder 
until perfectly dry and healed. The hands 
should be clean and disinfected when dress- 
ing the cord, in order to prevent infection 
of the navel. When dressing the baby 
first put on the band, roll it around the 
body rather snugly and sew it; then put 
on the diaper, shirt, stockings, and bootees, 
flannel petticoat and dress. The two 
latter should be drawn up from the feet, 
not put on over the head. After baby 
is bathed and dressed wrap him in a 
clean flannel shawl or square, and put him 
in his crib or basket. The baby should 
not be handled or exhibited to visitors, nor 
disturbed more than is necessary. 

Sleep. A newly born infant should sleep 



THE LYING-IN PERIOD 121 

most of the time. Do not take it up when- 
ever it cries. This is a very bad plan to 
start out with. Many babies become ner- 
vous and spoiled early in life from being 
indulged in this way. If the baby cries 
examine it carefully. If it is wet change 
the diaper for a dry one. If the hands and 
feet are cold place hot-water bags in the 
crib. Change the baby's position a little, 
but do not take him up, walk with or 
rock him. To be made comfortable, kept 
warm, and fed regularly is about all the 
attention a baby requires during the early 
months of life. This done, he makes little 
trouble for those about him. 

Bowels. A normal baby between the 
time of birth and the first twenty -four 
hours passes a black or dark - greenish 
movement. This is called meconium; 
movements of this type continue for a 
few days, gradually becoming lighter until 
on the fourth or fifth day they become 
a bright-yellow color, smooth and pasty. 
During the first two weeks there may be 
from three to six stools daily. After the 
first month they average two or three each 
day. During the early weeks small soft 



122 BEFORE THE BABY COMES 

lumps are apt to appear in the movements, 
which may cause the mother or nurse to 
think the milk is not properly digested and 
that the baby needs something in the way 
of medicine to aid digestion. Medicines 
will do no good. These little lumps are 
normal waste, not enough in bulk to make 
a smooth stool; as the mother's milk im- 
proves these lumps disappear. 

Urine. A baby usually passes urine at 
birth or when it passes meconium; but the 
diapers should be watched; if no urine is 
passed in twenty-four hours report the 
fact to the doctor. Normal urine does 
not stain the diaper, but these should be 
washed after every change; if not, the 
dried urine will irritate the skin and cause 
chafing. 

Nourishment. It is usual to place the 
baby at the breast six hours after birth. 
The stimulus of the nursing affects the 
uterus favorably, causing it to contract 
naturally and helping it to return to its 
natural condition. The first secretion the 
baby gets from its mother is not true milk, 
but what is called colostrum. This has a 
more or less laxative effect upon the in- 



THE LYING-IN PERIOD 123 

fant, which is beneficial. Milk comes usu- 
ally by the third day. During the two 
or three days while the milk is coming in 
the baby requires no other nourishment and 
should be put to the breast every three or 
four hours. A little boiled water may be 
given at intervals between nursings. Sugar- 
water, the popular fennel-tea, milk and 
water, or any artificial food should not 
be given. After the second or third day, 
when the milk-flow is established, the baby 
should be nursed every two hours during 
the day and three times at night until it is 
four weeks old. The mouth should be 
washed out with boric-acid solution before 
and after each nursing. Infant-feeding by 
breast and bottle is discussed in succeeding 
chapters. 



IX 

THE MOTHER AND BABE 

THE first baby is a most serious prob- 
lem, and this in more ways than one. 
There are two classes of young mothers 
who are especially to be pitied; first, those 
who are entirely devoid of experience, who 
before marriage have been happy, light- 
hearted, and tenderly cared for, who have, 
never taken any special thought for the fu- 
ture. That maternity should bring cares 
and responsibilities has never been a 
thought with them. But when it does 
come only too many young mothers find 
themselves completely overwhelmed by 
their ignorance and wholly at a loss as 
to what is right to do for their first-born, 
and struggle on as if blindfolded. 

The young mothers of the second class 
are usually as totally lacking in experience as 



THE MOTHER AND BABE 125 

those of the first, but, feeling responsibility 
for the future, they have made it a duty to 
conscientiously absorb many beautiful but 
wholly impracticable theories. Now, theo- 
ries in most cases have proved rather dis- 
astrous experiments where infants are con- 
cerned, and I am inclined to think that 
this type of mother is more to be pitied 
than the first. Hers is the keen disap- 
pointment of seeing her cherished dreams 
crumble and fall one by one and of com- 
mencing again from the beginning to learn 
by a rather stern experience. Mother love 
and instinct are strong, barring a few ex- 
ceptional cases, and these go a long way 
in helping the young mother over what 
is probably one of the most trying experi- 
ences which have so far come to her. 

But what a young mother lacks in experi- 
ence must necessarily be judiciously gained 
from others. I say judiciously, because 
the young mother usually is helpless under 
a deluge of advice which comes from kind 
and well-meaning friends, themselves with- 
out experience, but rich in theory, or from 
mothers and grandmothers who have 
brought up large families. Most of this 



126 



BEFORE THE BABY COMES 



advice is probably a quarter of a century 
or more old, and in many ways is bound 
to be behind the times. Grandmothers, 
too, we all know, are apt to be more or 
less prejudiced in matters pertaining to 
their grandchildren and insist upon in- 
dulgences which would not have been 
tolerated with their own babies. 

Then there is the advice of the mother 
(and it is usually well worth listening to) 
who has weathered the early trials of 
motherhood and, with her little family of 
three or four, has grown wise by the ex- 
perience which is the best teacher. 

In the mean time what of the poor infant, 
who is the other sufferer? To my mind 
the first baby is indeed a martyr and the 
victim of many experiments. A large 
number of babies, especially the first-born, 
suffer from lack of proper knowledge on the 
part of the mother, who, in her anxiety to 
do right, frequently overdoes it. It is un- 
doubtedly true that much of the sickness 
and many of the deaths among infants 
under three months are due to lack of 
knowledge, bad management, and mistakes 
made in the beginning. 



■ 



THE MOTHER AND BABE 127 

Many lessons can be learned from a 
casual study of animal nature, and any one 
who has had experience with domestic 
animals will know that there is nothing so 
good for very young and new-born crea- 
tures as to leave them alone to the care of 
the mother. Instinct teaches her to select 
a soft, warm place for her offspring; she 
washes them, feeds them, and guards them 
with a watchful eye. 

Moderation, if practised in everything 
that pertains to the baby, will prove a safe- 
guard to the mother and start her on the 
right path. It will give her time to reason 
out and solve many problems calmly and 
intelligently. 

The early cry, which is painfully trying 
to some young mothers, especially to a 
nervous one, becomes less distressing if she 
stops to think that the lungs, never having 
been used, need exercise in order to make 
them strong. For the first three months 
the infant is too weak, even with a fair 
amount of crying, to develop the lungs to 
more than one-third their normal capacity, 
and that these organs cannot be considered 
perfect until they are inflated to their 



128 BEFORE THE BABY COMES 

utmost is enough to make her tolerant of a 
fair allowance of crying. A year of simple 
breathing would not accomplish as much 
toward developing the lungs as a moderate 
amount of crying each day for a month. 
It is the deep inhalation, such as accom- 
panies a good cry, which alone can make 
the lungs strong. Healthy infants cry 
normally, and they should be allowed to do 
so a portion of each day. When the cry is 
whining or continuous it is usually caused 
by over-indulgence of some kind or by 
mistakes, such as handling the baby when 
he is more comfortable if left alone. Sleep- 
ing in bed with older persons is bad for a 
baby; it draws upon the vitality. All 
babies sleep better and are healthier if put 
to bed in their own little cribs, with all 
clothing removed with the exception of 
shirt, band, and diapers. The nightgown 
should be warm, also the coverings. Young 
infants should have a hot-water bag in the 
bed, especially in cold weather, and the 
feet should never be allowed to become 
cold. Otherwise leave them undisturbed, 
and they thrive, usually, without a draw- 
back. 



THE MOTHER AND BABE 129 

In this the animal kingdom furnishes the 
human mother with an object-lesson, and 
it will pay her also to extend her lesson in 
observation still further and note that 
when these baby animals are mauled and 
petted and carried about they do not 
thrive, but pine away and die. 

Let us follow the life of an infant for the 
first three months. We will not theorize, 
neither will we experiment; a new-born 
infant is too tender and delicate for this. 
We will confine ourselves to facts which 
have been demonstrated over and over 
again with a great many babies of all kinds 
and through many years of experience. 
With the new-born infant we have a tiny 
bit of humanity in our hands as absolutely 
helpless and as dependent upon us as are 
the offspring of animals upon their parent. 
We have a human life at a tender age, 
when it is most plastic and easy to mold 
physically and mentally. We would first 
advise the young mother to go slowly and 
feel her way carefully, and never go to 
extremes. 

For the first week or two the infant re- 
quires but little care; he must be bathed, 



i 3 o BEFORE THE BABY COMES 

dressed, fed, and kept warm, otherwise for 
the most part left alone to gradually learn 
that he is alive, to make use of his different 
organs and senses. This process of de- 
velopment, while feeble, is quite as much 
as he is able to stand; it must come slowly; 
do not attempt to force matters where he is 
concerned. He does not require handling 
other than what is necessary during the 
process of bathing and dressing, with an 
occasional turning from side to side, simply 
to change the position. More than this is 
not good for him. Then he must be kept 
warm. To do this, remember, it is not nec- 
essary to overburden him with wraps or 
keep the room at a hothouse temperature ; 
if you do you will have a baby as tender 
as a forced plant. Select the clothing for 
its lightness and warmth combined; if the 
weather is at all cool be sure that each 
little garment is warm before putting it on 
the body. Do not put the socks on while 
the feet are cold; warm these little mem- 
bers with your own warm hands or before 
an open fire. Warm the hands in the same 
way and, if necessary, draw a pair of 
worsted mittens over them, and let them 



THE MOTHER AND BABE 131 

remain for a while until the hands are 
perfectly warm. Have a little afghan 
always ready to throw over the child. A 
very thin comfortable made of eiderdown 
is ideal for this purpose, as it is exceedingly 
light in weight and surprisingly warm; it 
is also the best possible covering at night. 

For the first few days, until the baby has, 
so to speak, become acclimated, I would 
advise that the temperature of the room 
be kept at 72 degrees Fahrenheit; after 
this it may be 70 degrees. Try to keep 
the temperature as even as possible, as it 
would be better to keep it at an even, low 
temperature than at a varying high one. 

For the first few days let us also be care- 
ful of light. The experienced gardener 
would not think of transplanting a young 
plant from the shade in the greenhouse or 
garden without carefully protecting it from 
the strong light for a few days, until it has 
become accustomed to the change and its 
new surroundings. It is very much the 
same with the baby. Let the new baby ac- 
custom his eyes gradually to the daylight. 
For the first day the light in the room 
should be rather subdued; the next day a 



i 3 2 BEFORE THE BABY COMES 

little more light may be let in, and finally 
the bright sunshine ; but always be careful 
that none of this shines directly in the 
baby's eyes, that the face is always turned 
from any bright light, such as electric and 
incandescent light or lamp. Turn the child's 
eyes away from the window through which 
the sun shines, especially if there is a very 
light shade or if the walls in the room are 
white; there should always be some means 
taken to shade the eyes from the glare. 

Of fresh air the infant should have 
plenty. At first he should be taken from 
the nursery for an hour every day, and the 
room should be aired thoroughly. When 
the windows have been closed and the 
room is about 68 or 70 degrees bring the 
baby back wrapped in his little blanket, 
which should not be removed until the 
room is the proper degree for an infant a 
few days old. In the course of a few days 
more let the temperature of the room be a 
few degrees lower when the baby is brought 
back. Every few days lower the tempera- 
ture a degree or two until, by the time the 
baby is a month or six weeks old, he has 
become accustomed to taking into his lungs 



THE MOTHER AND BABE 133 

air of various degrees of coldness. Then 
we have him ready to go out into the clear, 
fresh air without danger of taking cold. 

At the end of seven or eight weeks the lit- 
tle new-comer is beginning to wake up and 
to realize the fact that he is living. If he is 
allowed to have the slow, peaceful life that 
has been suggested, this gradual awakening 
is a thing of joy to him and a delight to 
those about him. His eyes have now be- 
gun to follow you about the room, or they 
will fasten themselves upon some object; 
a little gurgle of delight escapes him; later, 
sweet smiles are continually lighting up 
the little face as he becomes more than half- 
way conscious of life and the things about 
him. His dimpled hands and feet attract 
him, he attempts to put them in his mouth, 
and after days of effort he at last suc- 
ceeds in placing them, with a moderate 
amount of accuracy, where he wants them. 

All this is work and amusement for the 
little one, and is, in his small way, as much 
as he is capable of. When the baby has 
reached this period he is beginning to leave 
the vegetating age behind him and re- 
quires a little more attention, He is 



134 BEFORE THE BABY COMES 

heavier, consequently his position needs 
to be changed more often to prevent his 
becoming tired. He is stronger and uses 
his legs more vigorously; now the clothes 
should be shortened to give the muscles 
of the legs more chance to develop. He 
should also have a longer time in the open 
air, and more fresh air may be let into the 
room at night. With this his appetite in- 
creases and more food is necessary; he is 
more intelligent and requires more enter- 
tainment, but as his own powers in this 
direction have increased fourfold in this 
surprisingly short period he is perfectly able 
to look out for himself in this respect. It 
is not necessary to help him; let him 
amuse himself instead of providing enter- 
tainment for him. 

Comparatively few children are born 
diseased; the average new-born baby is 
normal and healthy, and in starting out the 
young mother should always have this 
fact in mind to comfort her; it should give 
her confidence in herself and in her ability 
to keep the baby in this healthy condition. 
Disease is not easily acquired by the new- 
born child. 



X 

CLOTHING THE BABY 

IN selecting clothing for a baby there 
are three things to be considered — 
health, comfort, and simplicity. Little 
babies do not store up a great amount of 
animal heat, and their little bodies chill 
easily. It is necessary that their clothing 
be warm enough at all seasons to prevent 
the waste of what little heat they have, as 
their energy and vitality are dependent 
upon its being conserved. It is especially 
necessary that the chest and the abdomen, 
which inclose the most important vital 
organs — lungs, heart, stomach, and in- 
testines — should hold their heat. Infants 
do not feel the heat of summer as much as 
is often supposed, and many infantile dis- 
orders of this season can frequently be 
traced to the fact that these parts of their 



136 BEFORE THE BABY COMES 

bodies have not been kept sufficiently 
warm. Neither should a baby be over- 
weighted with clothing in the winter. Ex- 
tremes are to be avoided both in summer 
and in winter. For warmth and comfort, 
well-fitting garments are much to be pre- 
ferred to the loose garment of the kimono 
or Princess style. Such garments are apt 
to be cold and will gather about the body 
in uncomfortable wrinkles and bunches. 

Band. For the first five weeks of life use 
a simple band torn from a strip of flannel 
thirty inches long. Each strip should be 
seven inches wide. It is not necessary to 
hem these, but finish with wide button- 
hole stitch. At the end of five weeks re- 
place these with the ribbed or knitted 
band. For both summer and winter these 
bands should be light in weight, containing 
one half wool and the other half cotton 
or silk. They should be long enough to 
reach from armpits to thighs. The shirts 
should be of the same ribbed material, 
light weight for summer, medium for win- 
ter. They should have long sleeves and 
fasten down the front. A light-weight 
flannel petticoat made with a muslin waist 



* 



CLOTHING THE BABY 137 

should be worn summer and winter. Pin- 
ning-blankets are not necessary. A white 
petticoat is not essential, but one should 
always be worn under a dress of fine, sheer 
material. 

Length of Clothing. Dresses and petti- 
coats should not be longer than twenty-six 
inches. Anything beyond this length adds 
a needless weight for the little body to 
carry. If much shorter than twenty-six 
inches they do not afford sufficient warmth 
and protection to the legs and feet. 

Dresses should be simple and may be 
made of as fine material as the mother's 
means will allow; this makes little differ- 
ence, how ever, as long as the garments 
are neatly made and there are enough to 
keep the baby spotlessly clean. 

Nightgowns should be made of light- 
weight flannel for winter and cambric or 
longcloth for summer. They should be 
made long enough to turn up and button 
at the bottom, or drawn together with a 
draw-string so as to prevent the feet from 
kicking out and becoming exposed to the 
cold. 

Diapers. The best material for diapers 



138 BEFORE THE BABY COMES 

is fine cotton bird's-eye. Four dozen at 
least are necessary. One-third should be 
eighteen inches wide and thirty-six inches 
long; these should be used for the first 
two or three months. The remaining two- 
thirds should be twenty-two inches wide 
and forty-four inches long. Old table- 
linen cut into appropriate-sized squares 
makes ideal diapers for the first weeks, or as 
long as they will last. Cheese-cloth and 
outing-flannel are not suitable for diapers. 
The latter soon becomes harsh and thin, 
and both cause the baby to become chafed. 

Number of Garments Required 

4 to 6 dresses (2 yards for each of yard -wide 
material). 

4 to 6 nightgowns (ij4 yards for each of yard- wide 
material). 

4 to 6 petticoats (2 yards for each of yard- wide 
material). 

4 to 6 flannel petticoats (1 T A yards for each of yard- 
wide material). 

4 to 6 flannel ribbed bands. 

2 to 4 wrappers, outing-flannel or fine flannel (iH 
yards of yard -wide material). 

4 to 6 ribbed or knitted shirts (it is best to get No. 2 
size, as the first size is outgrown so quickly). 

4 pairs of bootees. 






CLOTHING THE BABY 139 

4 pairs of woolen stockings for winter, or wool and 

cotton or silk for summer. 
2 flannel squares or shawls. 
4 to 6 dozen diapers. 
A cap and coat will be needed later when the baby 

is old enough to go out. 

The baby's basket is usually about six- 
teen by twenty inches square and four or 
five inches deep. It should contain : 

1 small soft brush and fine comb. 

6 wash-cloths, made of bird's-eye linen or cheese- 
cloth 8 inches square. 

4 to 6 soft linen towels. 

1 small pair of scissors with blunt points. 

A small package of absorbent cotton or small squares 
of soft, old linen for washing out mouth and eyes. 

1 tube of white vaseline. 

1 box of good talcum powder. 

1 paper, each, of large and small safety-pins. 

Thread and needles. 

Pincushion. 

Other things necessary are: 

A small cup for boric-acid solution. 
A bath-tub of rubber, agate, or tin. 
A cake of Castile or other mild soap. 

1 agate basin. 

2 pitchers for hot and cold water. 

10 



i 4 o BEFORE THE BABY COMES 

i bath thermometer. 

A covered pail for soiled diapers. 

Crib. A white-enameled metal crib is to 
be preferred to any other kind, or a large 
clothes-basket may be used for the first 
month or two. This should be padded in- 
side with a padding made of cotton-batting 
and cheese-cloth. The bedding for both 
crib and basket is the same. The crib 
should have a woven mattress instead of 
narrow strips of iron on which to place the 
bedding. A heavy gray blanket, folded to 
fit the basket or crib, makes a sanitary and 
soft mattress. Over this there should be a 
square of rubber sheeting. From six to 
eight sheets and six pillow-slips are neces- 
sary. The pillow should be made of silk 
fiber, down, or hair. It should be eighteen 
by twenty-two inches square and not over 
two and one-half inches thick. There 
should be one pair of woolen crib blankets 
and a small comfortable of down or lamb's 
wool. Cotton blankets or comfortables 
are not warm enough for a baby. 






XI 

BREAST-FEEDING 

THROUGHOUT the entire animal king- 
dom each species is provided by- 
nature with nourishment particularly 
adapted to its peculiar kind of young. 
The food provided for the human baby 
and the one on which it thrives best is its 
mother's milk. As the first few months 
of infancy are the most telling ones for a 
good start in life, it is only fair to the child 
that its mother should make a conscien- 
tious effort to nurse her baby. The ex- 
ceptions when a mother should not nurse 
her baby are when she has tuberculosis or 
any specific disease, either inherited or 
acquired; when she is insane, given to 
alcoholic excesses, or is extremely anemic. 
To get the best results the nursing mother 
must expect, during lactation, to deprive 



142 



BEFORE THE BABY COMES 



herself of some of her outside interests 
and pleasures and devote herself to this 
one thing. If she indulges in pleasures 
to the extent of keeping irregular or late 
hours she cannot expect to successfully 
nurse her baby. She must be temperate 
in both diet and mode of living. The 
nursing period should last from six to 
twelve months; not over the latter period, 
unless there is some unusually good reason 
for doing so, as in these days of high- 
pressure living it is doubtful if it is good for 
the mother or the child. 

Few women are able to successfully pro- 
long the nursing period beyond the eighth 
month; usually they must give it up a 
month or two earlier. I would advise 
every nursing mother to start during the 
first month, or even the first week, by 
giving the baby one bottle-feeding a day 
of a formula suitable for its age; this in 
view of the fact that the weaning period is 
sure to come sooner or later, often from 
some unforeseen happening instead of in 
the ordinary course of events. It is well, 
therefore, to accustom the stomach at an 
early age to two kinds of milk; then if it 



BREAST-FEEDING 143 

becomes necessary to force the weaning 
suddenly it is not such a difficult under- 
taking. A sudden change from breast to 
cows' milk or any infant food is not de- 
sirable for an infant, especially a very 
young one, with his delicate and unde- 
veloped organs of digestion; neither is it 
rational to expect the stomach of the in- 
fant to accept nourishment intended for the 
calf, with its different physical and mental 
requirements, without some altering and 
adaptation. 

Regularity in Feeding. The first three 
months of an infant's life are by far the 
most important of the first year; if they 
have been well started the mother has 
little to fear for the future, for in these 
quiet months of development and growth 
a store of strength and endurance has been 
husbanded for future emergencies, should 
such arise. To give a baby a right start in 
life it must be fed regularly and not too long 
at a time; twenty minutes at a feeding is 
long enough. The baby should not be 
allowed to nurse for a few moments, stop 
and play, then turn to the breast again. 
If allowed to do this the child will often 



i 4 4 BEFORE THE BABY COMES 

be a whole hour taking his food, and 
hardly finish one meal before it is time 
to be fed again. Children rarely thrive 
on irregular feeding, as it causes gastric 
disturbances. 

During the first four weeks a baby 
should be fed every two hours ; during the 
day seven feedings, three feedings at night 
between 7 p.m. and 7 a.m. Prom the 
fourth to the sixth week feed every two and 
one-half hours, with two feedings at night, 
usually at 10 p.m. and one between this 
and morning. From the sixth week the 
baby should be nursed once in three hours, 
with two night feedings. If there is an 
abundance of milk the baby should nurse 
one breast at each nursing, alternating 
them. If the supply is not abundant both 
breasts may be used at each feeding. If 
the baby is asleep at feeding- time he should 
be awakened; this will not be necessary 
more than a few times, as babies form 
habits quickly, and in a few days the habit 
of regularity in meals will become estab- 
lished, and the child will be awake and 
ready a few minutes before meal-time. 
As it takes a little baby at least two hours 



BREAST-FEEDING 145 

to digest its food, and as he grows older 
from two and one-half to three hours, much 
harm is done if he is fed more often. As 
one meal is not thoroughly digested and 
passed from the stomach into the intestines 
before another one is taken, this overworks 
the little stomach and causes indigestion 
and vomiting. On the other hand, if the 
baby is allowed to sleep for perhaps an 
hour or more past his meal-time he be- 
comes so ravenously hungry, and when 
nursed takes his food so greedily, that he 
gets far more than his small stomach is 
capable of holding. It stretches and be- 
comes over-distended, and vomiting and 
indigestion again result. It might be well 
to know that the baby's stomach the first 
few weeks of life is barely the size of a 
large hen's egg. 

Complications in breast-feeding are not 
uncommon. There are several reasons for 
this. Not infrequently during the early 
months soft curds or watery substance 
may be vomited between meals; the stools 
may be thin, tinged with green, or have 
soft, fatty curds in them; there may be 
colic also. When this condition occurs do 






i 4 6 BEFORE THE BABY COMES 

not be persuaded that your milk does not 
agree with the baby and discontinue nurs- 
ing it. It is usually because the milk is too 
rich in cream or fat, and the remedy is 
much more simple than weaning the baby 
and giving it cows' milk or an infant food. 
Immediately before every nursing give the 
baby a tablespoonful of boiled water that 
. has been cooled to the temperature of 
breast milk, which is about 98 degrees, and 
nurse the baby fifteen minutes instead of 
twenty. The mother should exercise more, 
get more fresh air, eat less meat and cereals 
and more green vegetables, if possible. If 
she is drinking much milk, cut it down to 
one-half the quantity. In a very short 
time this trouble will right itself ; then the 
water may be reduced or stopped. 

Colic. When a nursing baby has colic, 
but otherwise its digestion appears to be all 
right, it is usually caused by lack of exer- 
cise, nervousness, or constipation on the 
part of the mother, or possibly because 
the baby is not kept warm enough. The 
abdomen should always be protected by a 
woolen band, and the hands and feet kept 
warm. The remedy for colic in a nursing 



BREAST-FEEDING 147 

baby is for the mother to overcome the 
cause in herself. 

Vomiting, If a nursing baby vomits im- 
mediately or shortly after taking its food 
it is because it is fed too often or nurses too 
long at a feeding. In consequence the tiny 
stomach gets more than it can hold, and the 
surplus food comes back; but this also 
stretches the stomach, and over-distention 
of the delicate stomach-tissue frequently 
causes chronic indigestion. If the vomit- 
ing is frequent it is best to make the feed- 
ings farther apart or else nurse the baby 
but fifteen minutes at a feeding. 

When a baby nurses eagerly for a few 
moments, then drops the breast and cries, 
or when it cries after each feeding and sucks 
its fingers right after and between meals, 
it is usually a sign that there is not enough 
nourishment, and breast milk must be sup- 
plemented by cows' milk. The best way 
to determine whether a nursing baby is 
getting the proper amount of food is to 
weigh him immediately before and after 
each meal. The gain in weight represents 
the amount of nourishment the child re- 
ceives. A baby under one month should 



148 BEFORE THE BABY COMES 

gain from two to four ounces ; from one to 
three months, three to five ounces; and 
from four to eight months, five to seven 
ounces. If, after nursing, the gain is less 
than the minimum number of ounces men- 
tioned above the baby is not getting enough 
food, and breast-feeding should be supple- 
mented with properly diluted cows' milk. 
This is one of the occasions where the one 
bottle-feeding, before mentioned, comes in 
well; it also gives the mother a chance, 
once in a while, to get a little rest or an 
extra hour or two of much-needed recrea- 
tion. I would advise in the case of all 
breast-fed babies at the third month the 
mother add a second bottle-feeding, an- 
other at the sixth month, and keep on in 
this way, so that by the tenth or twelfth 
month the baby is entirely weaned. This 
method is far more safe than to attempt 
sudden weaning or to prolong nursing be- 
yond the twelfth month. 

The signs of thriving are when a baby 
takes its food well, does not vomit, has 
a soft yellow stool every day, and shows a 
steady increase in weight. At birth the 
average weight is from seven to seven and 



BREAST-FEEDING 149 

one-half pounds. During the first week 
there is usually a slight loss in weight; 
after this there should be a steady gain. 
The birth-weight is generally doubled by 
the sixth month, and the baby should 
weigh approximately three times the birth- 
weight at the end of the first year. 






XII 

BOTTLE-FEEDING 

WHEN it is impossible for a mother 
to nurse her child or for good rea- 
sons it is best for her not to do so the next 
best substitute is the milk of some animal, 
preferably cows' milk; but this should be 
changed or adapted to the stomach of the 
infant. By comparing the size of the in- 
fant to that of the calf, the strength of both 
at birth, their development in muscular 
growth, you will readily see why the milk 
of the cow, which is intended to develop the 
animal, is not in its natural state suitable 
for the human baby. 

Before birth the infant receives its 
nourishment through the mother by ab- 
sorption; this is sufficient to develop the 
organs up to the time of birth. At birth 
the digestive organs are by no means per- 



BOTTLE-FEEDING 151 

fectly developed. They are still feeble, 
but with proper nourishment they begin 
to develop and grow stronger. Without 
going deeply into the chemistry of food, 
or puzzling the young mother with terms 
and names which would probably mean 
little to her, I would like to impress upon 
her a few simple facts to be remembered 
concerning the composition of milk, that 
she may more intelligently prepare her 
baby's food. 

All milk is composed chiefly of these 
elements: protein, which is a muscle and 
tissue builder, also produces heat and 
energy; carbohydrates (such as sugar), 
which produce fat and heat; and fat 
(cream), which performs about the same 
functions as the carbohydrates, producing 
possibly more fuel or heat. There are also 
certain mineral salts and water. The 
milk of all animals contains these elements, 
but in different proportions and consis- 
tency, according to the animal and its 
habits and requirements. For instance, 
the protein of cows' milk is much tougher 
and harder to digest than that of human 
milk. The fats are also much harder to 






152 BEFORE THE BABY COMES 

digest; but the fat in human milk contains 
a certain acid which causes it to melt at a 
much lower temperature than the fat of 
cows' milk, and the lower the melting- 
point of fat the easier it is to digest. 

Fortunately, the human stomach is very 
adaptable, and if the modifying of cows' 
milk is intelligently and carefully managed 
the infant will soon become accustomed 
to it, digest, assimilate, and thrive on it 
almost as well as on that provided by 
nature. 

Milk. Breast milk is practically sterile, 
so in selecting cows' milk for a baby it 
must be as nearly clean as possible. If 
one lives in a city be careful to procure 
the milk from a dealer who is reliable and 
responsible for the cleanliness and purity 
of his milk. The milk that comes from in- 
spected dairies where it is bottled and 
sealed before sending to the city is best. 
Milk that comes to the dealer in bulk and 
is dipped from the can into bottles, pails, 
or pitchers is not fit for babies' food. 
Those who live in the country should 
make sure that their milk comes from 
clean cows kept in clean stables, and that 



BOTTLE-FEEDING 153 

the milkers' hands, clothing, and pails are 
clean. All milk contains a certain amount 
of bacteria. These for the most part will 
not cause harm unless found in very large 
numbers, but a small number will multiply- 
by millions and billions if the milk is al- 
lowed to stand long in a warm atmosphere 
after it comes from the cows. 

While these germs have little effect on an 
adult, when taken into the delicate stomach 
of an infant they are very irritating and 
cause vomiting, diarrhea, and inflamma- 
tion. Milk intended for a baby should be 
placed in a clean receptacle and rapidly 
cooled as soon after it comes from the cow 
as possible. It should then be sealed and 
kept cool until it is time to use it. Milk 
over-rich in cream, such as usually comes 
from Jersey cows, is too rich for most 
babies, especially in hot weather. Extra 
cream added to cows' milk is not a desir- 
able addition to babies' food unless during 
the first month of a premature or very 
delicate underweight baby's life. The 
milk of a single cow will often vary in rich- 
ness from day to day, frequently between 
morning and night milkings; consequently, 



154 BEFORE THE BABY COMES 

the milk from several or a herd of cows is 
best, for the milk will be more uniform. 
Milk should be carried to the consumer 
with the container packed in ice or placed 
in very cold water, so that it is delivered at 
a low temperature. Here the responsi- 
bility of the dealer ceases and that of the 
consumer commences. 

Milk should not be allowed to stand on 
door-steps, in areaways, or in hot kitchens. 
If it does, all the care and pains of the 
dairyman will be undone. Every mother 
should be over-particular about these two 
essential points — i.e., cleanliness and keep- 
ing the milk cool. Now that we know 
what is desirable in the milk and handling 
of it, the next point to be considered is the 
diluent. Water is an excellent one, has 
the advantage of costing nothing and of 
always being on hand. It may contain 
impurities, however, so it must be boiled 
before using and set aside to cool in pitcher 
or jar, covered with a piece of cheese-cloth 
or a clean towel, to keep out dust and 
insects. Having had unusual opportuni- 
ties for the study of infant-feeding and the 
effect of diluents, my experience has been 



BOTTLE-FEEDING 155 

that milk, when diluted with a thin gruel, 
is under most conditions more easily 
digested by infants than when water alone 
is used. 

The exceptions are when, occasionally, 
during the first few weeks of life, the in- 
fant has some difficulty in digesting the 
starches these gruels contain; in this case 
the gruels may be dextrinized, thus over- 
coming the difficulty, or boiled water 
may be used for a month or two. Then 
I would advise using gruel. The best 
gruels for diluents are made of either bar- 
ley, wheat, oat, or legume (bean) flour; 
under ordinary circumstances the first- 
named is the best all-round flour for mak- 
ing gruel, as a diluent for milk, in infant- 
feeding. The following formulas are in- 
tended for infants from one week up to one 
year of age; and under ordinary circum- 
stances, with cleanliness and care, they 
should suit the digestion of almost any 
healthy infant. At the same time it must 
be remembered that no set of formulas or 
rules can be applied alike to all infants. 
Your baby is an individual baby; these 

formulas are made for the average one, 
11 



156 



BEFORE THE BABY COMES 



consequently it is necessary to use judg- 
ment in adapting these formulas. 

When weaning a baby from the breast 
to cows' milk always select a formula for a 
baby a month or two younger than the age 
of the child, gradually working up to the 
one indicated for his age. When starting 
a baby of a week or two on a formula if it 
disagrees with him and causes vomiting 
weaken the food a little for a few days by 
taking away one or two teaspoonfuls of 
milk and replacing them with water or 
gruel. Then work the formula up to the 
original one by adding the milk at the 
rate of a half teaspoonful every few days. 

Whenever the food is increased or made 
stronger do not become alarmed if the 
baby at first vomits one or more of its 
feedings or if the food causes a change in 
the character of its movements. Some 
little upsetting is not at all unlikely to 
occur under these circumstances. Give 
the stomach twenty-four hours to become 
accustomed to the change ; then if matters 
do not right themselves go back to the 
former formula and make the change more 
gradual. Then, again, do not look to the 



BOTTLE-FEEDING 157 

food as being the cause of every upsetting 
or ailment that occurs in the child. It is 
a great mistake to lay every disturbance 
to the food; a new tooth, some unusual 
excitement in the way of visitors, or a 
slight cold might disturb the digestion 
for a short time. 

Formula I (For First Week) 

Milk 1 3 ounces 2 

Sugar, granulated 1 teaspoonful 

Boiled water . 17 ounces 

Mix these ingredients and divide into 
ten equal parts; put these in ten separate 
bottles, seal with clean cotton-batting, and 
set in a cold place. To place the bottles in 
iced water is the best means of preventing 
the food from souring. Feed the infant 
the contents of one bottle once in two 
hours from 6 a.m. until 6 p.m., then one 
feeding at 9 p.m., 12 p.m., and 3 a.m., 
each. Warm the milk by placing the. bot- 
tle in hot water for a few moments ; do not 

1 Pour the milk into a bowl and stir so that the 
cream is evenly mixed with the rest of milk. 

2 Two tablespoonfuls are one ounce. 



158 



BEFORE THE BABY COMES 



remove the cotton stopper until the food is 
given to the child, then replace it with a 
black rubber nipple. Let a little of the 
food drop on the wrist to test the heat 
before giving to the child; never allow any 
one to test it by putting the nipple in the 
mouth. 

Formula II (For Second Week) 

Milk 4 ounces 

Sugar, granulated i teaspoonful 

Barley gruel or boiled water 17 ounces 

Salt a small pinch 

Prepare as in preceding formula. Divide 
into ten bottles; feeding-hours the same. 

Formula III (For Third Week) 
(Ingredients, same as preceding formulas.) 

Milk 6 ounces 

Sugar, granulated . 1 teaspoonful 

Barley gruel or boiled water 20 ounces 

Salt a small pinch 

Prepare as in preceding formulas. Di- 
vide into nine bottles ; feed every two and 
a half hours from 6 a.m. to 9 p.m., then 
a bottle at 12 p.m. and one at 3 a.m. 



BOTTLE-FEEDING 1 59 

Formula IV (For Fourth Week) 
(Ingredients, same as preceding formulas.) 

Milk 7 ounces 

Sugar, granulated . . . 1 teaspoonful 

Barley gruel or boiled water 20 ounces 

Salt a small pinch 

Prepare as in preceding formulas. Di- 
vide into nine bottles, feed same as 
Formula III. 

Formula V (First to Second Month) 
(Ingredients, same as preceding formulas.) 

Milk 8 to 10 ounces 

Sugar, granulated . 1 teaspoonful 

Barley gruel or boiled water 18 to 20 ounces 

Salt a small pinch 

Prepare as in preceding formulas. Di- 
vide into eight bottles. Feed every three 
hours from 6 a.m. to 9 p.m., then a bottle 
at 12 p.m. and one at 3 a.m. 

Formula VI (Second to Third Month) 
(Ingredients, same as preceding formulas.) 

Milk 10 to 14 ounces 

Sugar, granulated . . . i}4 teaspoonfuls 

Barley gruel or boiled water 20 to 22 ounces 

Salt a small pinch 



i6o 



BEFORE THE BABY COMES 



Prepare same as preceding formulas, 
divide into seven bottles, feed every three 
hours from 7 a.m. to 10 p.m., then one 
feeding about 2 a.m. Later divide into 
six bottles, feed every three hours from 
7 a.m. to 10 p.m. No feeding after this 
until morning. 

Formula VII (Fourth to Sixth Month) 

{Ingredients, same as preceding formulas,) 

Milk . • 14 to 18 ounces 

Sugar, granulated . . . i^teaspoonfuls 

Barley gruel or boiled water 18 to 22 ounces 

Salt a small pinch 

Prepare as in preceding formulas. Di- 
vide into six bottles ; feed every three hours 
from 7 a.m. to 10 p.m. 



Formula VIII (Sixth to Tenth Month) 

{Ingredients, same as preceding formulas,) 

Milk 20-24 to 28 ounces 

Sugar, granulated . . i}4 teaspoonfuls 

Barley gruel .... 16-12 or 8 ounces 

Salt a small pinch 



BOTTLE-FEEDING 161 

Prepare as m preceding formulas. Di- 
vide into six bottles; feed as in Formula 
VII. 

TENTH MONTH 

During this month gradually reduce the 
barley-water by taking out one ounce 
every two or three days and replacing it 
each time with an ounce of milk, so that 
in the course of two weeks the child is 
getting whole milk. Also omit the sugar 
and salt. By the end of the tenth month 
six to eight ounces should be taken at 
each feeding, once in four hours. Reduce 
the amount of the 10 p.m. feeding one 
ounce every few nights until this feeding 
is entirely omitted. 

Commencing with the fourth month 
strained orange-juice or beef -juice may be 
given. Begin with one teaspoonful of 
either twice a day. This amount may 
be occasionally increased so that by the 
seventh or eighth month a baby can 
usually take one-half ounce of orange- 
juice or an ounce of beef -juice twice a day. 
These should be taken between two morn- 
ing and two afternoon feedings. Either 



i62 BEFORE THE BABY COMES 

will be found excellent in overcoming con- 
stipation. Beef-juice must be fresh and 
without taint when given to babies. As it 
decomposes easily, it is best not to give it 
during hot weather. Solid food in any 
form should not be given before the tenth 
month. 

At the tenth month a small quantity of 
well-cooked oatmeal or other cereal (com- 
mence with a teaspoonful) may be added 
to the diet. Meal-hours should be ar- 
ranged as follows : 

7 a.m., milk-and-barley gruel or plain milk, 8 
ounces. 

ii a.m., milk-and-barley gruel or plain milk, 6 
ounces, and a teaspoonful of cereal, well cooked, 
served with a little sugar and cream. This 
amount may be increased from day to day until 
a tablespoonful is given (that is, after it is cooked). 

3 p.m., milk and barley or plain milk, 8 ounces. 

7 p.m., milk and barley or plain milk, 8 ounces. 

io p.m., milk and barley or plain milk, 6 ounces. 

Orange-juice and beef-juice may be given between 
meals. 

ELEVENTH AND TWELFTH MONTHS 

7 a.m., milk, 8 to io ounces. 

ii a.m., milk, 6 to 8 ounces, twice a week, with a 



BOTTLE-FEEDING 163 

fresh egg (raw) beaten up in it; in a week or two 
the egg may be coddled instead of raw, or boiled 
very hard and the yolk crushed to a powder; the 
white must not be given in this case; on other 
days a cereal, which should be varied two or three 
times a week. 

4 p.m., milk, 8 to 10 ounces, with a small piece of 
white toast, zwieback, or cracker of the best 
grade only. 

7 p.m., milk, 8 to 10 ounces. 

Orange-juice and beef-juice may be given between 
meals. 

Water. Be sure to give the child from 
one to three teaspoonfuls of cool boiled water 
three times a day between meals. Boil the 
water fresh once or twice a day and keep 
in a clean bottle, corked and in a cool place. 

Cereals. All cereals should be cooked at 
least one hour in a double boiler, or one- 
half hour in a single boiler. In the lat- 
ter case they should be boiled hard and 
stirred constantly to prevent burning. A 
still better way to prepare cereals for 
children is to cook them in a fireless 
cooker overnight. A little salt should 
always be put in the water with which the 
cereal is cooked, and a little sugar and 
cream served with it. 



164 BEFORE THE BABY COMES 

Toast. For children toast should be 
made of bread at least twenty-four hours 
old, preferably bakers' bread, then cut in 
thin slices, and dried in a slow oven until 
white and crisp, not brown. 

Eggs should be very soft and evenly 
cooked through. To accomplish this place 
a saucepan of water over a hot fire. As 
soon as it comes to a boil remove it from 
the stove and drop the egg into the hot 
water. Let it remain there for five minutes, 
then remove and break the egg into a cup 
or saucer, and season with a very little 
salt. 

Barley Gruel. One teaspoonful of bar- 
ley flour mixed with a little cold water, 
then stirred into a pint of boiling water; 
boil fifteen minutes, and add a pinch of 
salt. Strain through a fine sieve or piece 
of cheese-cloth. After the third or fourth 
month two teaspoonfuls of barley flour 
may be used instead of one. 

Beef -juice No. i. One pound of round 
steak cut or chopped into fine pieces; five 
ounces of cold water. Place this in a cov- 
ered jar and stand it in a cool place over- 
night, or from six to eight hours, then strain 



BOTTLE-FEEDING 165 

through meat-press or cheese-cloth; season 
with a little salt. 

Beef -juice No. 2. One pound of round 
steak slightly broiled or baked in a hot 
oven. Cut it into pieces about two inches 
square and squeeze in the meat-press or 
lemon-squeezer; salt slightly. 

The juice obtained by either of these 
processes may be slightly warmed by 
placing the receptacle which holds it in 
warm water and constantly stirring it. 
Great care must be taken not to heat it too 
much, as the albumen will coagulate, thus 
detracting from its value and nourishment. 
The beef used must be absolutely fresh and 
without taint. 

Laxatives for the Mother 

Bran Gems. One quart of bran, one 
pint of flour, a little over a pint of milk, 
ten tablespoonfuls of molasses, one level 
tablespoonful of soda bicarbonate, and a 
pinch of salt. One or two of these when 
eaten with each meal should overcome the 
most stubborn case of constipation. 

Laxative Porridge. One -half pint of 
water, two tablespoonfuls of graham meal, 



i66 BEFORE THE BABY COMES 

and a pinch of salt. Cook in a double 
boiler for one hour, add a pint of milk, and 
steam for five minutes more. Strain and 
keep on ice until needed, when the mush 
may be warmed. 

Laxative Fig Paste. One pound of figs, 
two ounces of powdered senna leaves, one 
ounce of coriander seed, and enough brown 
sugar to make a paste. Grind the figs, 
senna, and coriander seed through a meat- 
grinder, then stir in sugar to make a paste. 
Small quantities of this may be taken on 
going to bed or after meals. 



INDEX 



Abdomen, changes in, 9, 

24. 
Abnormalities, 53. 
Abortion, 41, 42, 43, 44, 

45, 54- 

Afterbirth, 104. (See Pla- 
centa.) 

Amniotic fluid, 17. 

Appetite, loss of, 63. 

B 

Backache, 8, 84. 

Baths, 80, 81. 

Binder, abdominal, ill. 

breast, 86, 114. 
Bladder, 4, 23, 99, 111- 

112. 
Bowels, 2, 112, 113. 
Breasts, 22, 60, 85, 86, 
113, 114. 

abscess of, 116, 117. 



Caul, 17. 

Cervex, 5. 

Childbirth, difficult, 9, 10. 

painless, 67. 
Chorion, 15. 



Cleanliness, 89, 94, 95, 
101. 

Clothing, 82, 83, 85. 
Coitus, 29, 42. 
Colustrum, 22, 23, 122. 
Conception, 1 1 . 
Confinement, preparations, 
88. 

the bed, 90. 

articles to have ready, 

9i, 92, 93. 

Constipation, 8, 31, 32. 
relief of, 33, 34. 

Convulsions. (See Eclamp- 
sia.) 

Cord, umbilical, 15, 119, 
120. 

Corsets, 85. 

Cramps, in leg and back, 
61. 

Cravings, 62, 63, 77. 

Curettage, 42. 



Diarrhea, 31. 
Diet, 114, 115. 
Discharges, vaginal, 37. 
Displacements, 64, no. 
Douche, 37, 64, no, in 
Dry birth, 17. 



168 BEFORE THE BABY COMES 



E 



Eclampsia, 49. 

Embryo, development of, 

12, 13. 
Enemas, 34, 113. 
Eugenics, 51, 52. 
Exercise, 69, 70, 71. 
Eyes, 118. 



Fallopian tubes, 4, 6. 
Family, controlling size of, 

.54. 
Fertilization, 11. 
Feticide, 12. 
Fetus, development of, 13, 

14. 
Flatulence, 34. 
Food, 74, 75, 76, 77- 
Fresh air, 71, 72. 
Fruit, 76. 
Fundis, 5. 

G 

Germ-plasm, 53. 

H 

Hair, falling of, 62, 63. 
Heartburn, 40. 
Hemorrhage, 45, 46. 
Hemorrhoids (piles), 32, 

37. 
Hospitals, 105. 



Impregnation, 15. 
Irratibility, 42. 



Itching, 49. (See Pruri- 
tis.) 

K 

Kidneys, 4, 48, 79, 80. 



Labor, stages of, 10, 98. 
Lacerations, 7, 8, 101. 
Laxative, diet, 33, 112. 
Ligament, broad, 4. 

small, 4. 
Liver spots, 61. 
Lochia, 108. 
Lying-in period, 107. 

mother's nourishment, 
114. 

baby's nourishment, 
122. 

M 

Marital relations, 87. 

Maternal impressions, 65, 
66. 

Meconium, 121. 

Menstruation, 2, 21. 

Midwives, 106. 

Miscarriage, 41. (See Ab- 
ortion.) 

Morning sickness, 24. 

N 

Napkins, sterile, 108. 
Nausea, 27. 

relief of, 29, 30. 
Navel, 25. 
Nerves, 57, 58. 



INDEX 



169 



Nipples, abscess of, 116, 
117. 
inverted, 59. 



Oils, use of, 86. 
Ovaries, 4, 5, 6. 
Ovum, 5. 



Pains, 63, 64. 

labor, 98, 99, 100. 
Patent medicines, 68. 
Pelvis, 3. 
Perineum, 7. 
Pigmentation, 61. 
Placenta, 16, 100. {See 

Afterbirth.) 
Pregnancy, duration of, 19. 

hygiene of, 69. 

signs of, 20, 21, 22, 23, 
24, 25, 26. 

lubal, 6. 

late in life, 56, 57. 
Premature birth, 41, 119. 
Pruritis, 59. 

Q 

Quickening, 22, 25. 



Recreation, 73. 
Rectum, 4. 
Rest, 73. 
Rupture, 9. 



Saliva, excessive, 65. 
Shortness of breath, 64. 
Sleep, 73. 
Sleeplessness, 60. 
Solutions, boric -acid, 92. 

salt, 48. 
Sterilization, 93, 94. 
Swelling, of legs and feet, 
36. 



Teeth, 38, 39. 
Temperature, 109. 
Toxemia, 47. 
Traveling, 87. 
Tuberculosis, 46, 47. 

U 

Umbilical cord, 20, 21, 103. 
Unforeseen, the, 101, 102, 

103, 104. 
Urine, 49, 80. 
Uterus (womb), 4, 10, 18. 



V 



Vagina, 6, 7. 

changes in, 18. 

discharges from, 37. 
Veins, varicose, 19, 35, 36. 
Vomiting, 27. 
Vulva, 18, 19, 36. 



W 



Water, 79. 



170 



BEFORE THE BABY COMES 



THE BABY 
A 

Air, fresh, 132. 
Amusement, 133, 134. 

B 

Basket, contents 01, 139. 
Bath-tub, 139. 



Cereals, 163. 

Clothing, 135, 136, 137, 

138, 139. 
Colic, 146. 
Crib, 140. 
Crying, 127, 128. 

D 

Diapers, 137. 
Diluent, for milk, 154. 



First week, 129, 130, 131. 
Food, bottle, 150, 151, 

152, 153, 154, 155. 
formulas, 157, 158, 

159, 160. 
breast, 141, 142, 143, 

144, 145, 146. 
from 10th to 13th 



month, 161, 162, 
163. 



Grandmothers, 125, 126. 
Gruels, 155. 

M 

Milk, 151, 152, 153, 154. 
Moderation, 127. 

R 

Receipts, 163, 164, 165. 

S 

Sleep, 120, 121, 128. 
Soap, 139. 



The first baby, 124. 
Theories, 125. 
Thriving, signs of, 148. 



Vomiting, 147. 
W 

Water, 163. 

Weaning from breast, 156. 



THE END 



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